Obese Patients Benefit, but do not Fare as Well as Nonobese Patients, Following Lumbar Spondylolisthesis Surgery: An Analysis of the Quality Outcomes Database

Andrew K. Chan, Erica F. Bisson, Mohamad Bydon, Steven D. Glassman, Kevin T. Foley, Eric A. Potts, Christopher I. Shaffrey, Mark E. Shaffrey, Domagoj Coric, John J. Knightly, Paul Park, Michael Y. Wang, Kai Ming Fu, Jonathan R. Slotkin, Anthony L. Asher, Michael S. Virk, Panagiotis Kerezoudis, Anthony M. Digiorgio, Regis W. Haid, Praveen V. Mummaneni

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

BACKGROUND: Given recent differing findings following 2 randomized clinical trials on degenerative lumbar spondylolisthesis (DLS) surgery, there is a need to better define how subsets of patients fare following surgery. OBJECTIVE: To investigate the impact of obesity on patient-reported outcomes (PROs) following DLS surgery. METHODS: A total of 12 high-enrolling sites were queried, and we found 797 patients undergoing surgery for grade 1 DLS. For univariate comparisons, patients were stratified by BMI ≥ 30 kg/m2 (obese) and < 30 kg/m2 (nonobese). Baseline, 3-mo, and 12-mo follow-up parameters were collected. PROs included the North American Spine Society satisfaction questionnaire, numeric rating scale (NRS) back pain, NRS leg pain, Oswestry Disability Index (ODI), and EuroQoL-5D (EQ-5D) Questionnaire. RESULTS: We identified 382 obese (47.9%) and 415 nonobese patients (52.1%). At baseline, obese patients had worse NRS back pain, NRS leg pain, ODI, and EQ-5D scores (P <. 001, P =. 01, P <. 001, and P =. 02, respectively). Both cohorts improved significantly for back and leg pain, ODI, and EQ-5D at 12 mo (P <. 001). At 12 mo, similar proportions of obese and nonobese patients responded that surgery met their expectations (62.6% vs 67.4%, P =. 24). In multivariate analyses, BMI was independently associated with worse NRS leg pain and EQ-5D at 12 mo (P =. 01 and P <. 01, respectively) despite adjusting for baseline differences. CONCLUSION: Obesity is associated with inferior leg pain and quality of life - but similar back pain, disability, and satisfaction - 12 mo postoperatively. However, obese patients achieve significant improvements in all PRO metrics at 12 mo.

Original languageEnglish (US)
Pages (from-to)80-87
Number of pages8
JournalNeurosurgery
Volume86
Issue number1
DOIs
StatePublished - Jan 1 2020

Keywords

  • Lumbar
  • Obesity
  • Patient-reported outcomes
  • Quality Outcomes Database
  • Spondylolisthesis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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