PMID- 33009575
OWN - NLM
STAT- MEDLINE
DCOM- 20210413
LR  - 20210413
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 88
IP  - 2
DP  - 2021 Jan 13
TI  - Mild and Severe Obesity Reduce the Effectiveness of Lumbar Fusions: 1-Year 
      Patient-Reported Outcomes in 8171 Patients.
PG  - 285-294
LID - 10.1093/neuros/nyaa414 [doi]
AB  - BACKGROUND: Elevated body mass index (BMI) is a well-known risk factor for 
      surgical complications in lumbar surgery. However, its effect on surgical 
      effectiveness independent of surgical complications is unclear. OBJECTIVE: To 
      determine increasing BMI's effect on functional outcomes following lumbar fusion 
      surgery, independent of surgical complications. METHODS: We retrospectively 
      analyzed a prospectively built, patient-reported, quality of life registry 
      representing 75 hospital systems. We evaluated 1- to 3-level elective lumbar 
      fusions. Patients who experienced surgical complications were excluded. A 
      stepwise multivariate regression model assessed factors independently associated 
      with 1-yr Oswestry Disability Index (ODI), preop to 1-yr ODI change, and 
      achievement of minimal clinically important difference (MCID). RESULTS: A total 
      of 8171 patients met inclusion criteria: 2435 with class I obesity (BMI 
      30-35 kg/m2), 1328 with class II (35-40 kg/m2), and 760 with class III 
      (>/=40 kg/m2). Increasing BMI was independently associated with worse 12-mo 
      ODI (t = 8.005, P < .001) and decreased likelihood of achieving MCID (odds ratio 
      [OR] = 0.977, P < .001). One year after surgery, mean ODI, ODI change, and 
      percentage achieving MCID worsened with class I, class II, and class III 
      vs nonobese cohorts (P < .001) in stepwise fashion. CONCLUSION: Increasing BMI is 
      associated with decreased effectiveness of 1- to 3-level elective lumbar fusion, 
      despite absence of surgical complications. BMI >/= 30 kg/m2 is, therefore, a risk 
      factor for both surgical complication and reduced benefit from lumbar fusion.
CI  - Copyright (c) 2020 by the Congress of Neurological Surgeons.
FAU - Mulvaney, Graham
AU  - Mulvaney G
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
FAU - Rice, Olivia M
AU  - Rice OM
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
FAU - Rossi, Vincent
AU  - Rossi V
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
FAU - Peters, David
AU  - Peters D
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
FAU - Smith, Mark
AU  - Smith M
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
FAU - Patt, Joshua
AU  - Patt J
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
FAU - Pfortmiller, Deborah
AU  - Pfortmiller D
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
FAU - Asher, Anthony L
AU  - Asher AL
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
FAU - Kim, Paul
AU  - Kim P
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
FAU - Bernard, Joe
AU  - Bernard J
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
FAU - McGirt, Matthew
AU  - McGirt M
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
AD  - Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 
      Charlotte, North Carolina.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
MH  - Adult
MH  - Aged
MH  - Body Mass Index
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Lumbar Vertebrae/surgery
MH  - Middle Aged
MH  - Obesity/*complications
MH  - Patient Reported Outcome Measures
MH  - Quality of Life
MH  - *Recovery of Function
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Spinal Fusion
OTO - NOTNLM
OT  - Body mass index
OT  - Lumbar fusions
OT  - Obesity
OT  - Surgical effectiveness
EDAT- 2020/10/04 06:00
MHDA- 2021/04/14 06:00
CRDT- 2020/10/03 05:32
PHST- 2020/03/17 00:00 [received]
PHST- 2020/07/05 00:00 [accepted]
PHST- 2020/10/04 06:00 [pubmed]
PHST- 2021/04/14 06:00 [medline]
PHST- 2020/10/03 05:32 [entrez]
AID - 5917484 [pii]
AID - 10.1093/neuros/nyaa414 [doi]
PST - ppublish
SO  - Neurosurgery. 2021 Jan 13;88(2):285-294. doi: 10.1093/neuros/nyaa414.