PMID- 34559749
OWN - NLM
STAT- MEDLINE
DCOM- 20210928
LR  - 20210928
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 46
IP  - 20
DP  - 2021 Oct 15
TI  - The Effect of Morbid Obesity on Complications, Readmission, and Patient-Reported 
      Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion: An 
      Inverse Propensity Score Weighted Analysis.
PG  - 1394-1401
LID - 10.1097/BRS.0000000000004059 [doi]
AB  - STUDY DESIGN: Retrospective review of prospectively collected data at a single 
      institution. OBJECTIVE: To compare perioperative and clinical outcomes in 
      morbidly obese patients who underwent minimally invasive transforaminal lumbar 
      interbody fusion (MiTLIF). SUMMARY OF BACKGROUND DATA: Obesity remains a serious 
      public health concern. Obese patients who undergo lumbar fusion have historically 
      thought to be at higher risk for complications and fare worse regarding 
      quality-of-life outcomes. However, recent literature may demonstrate comparable 
      risk and outcomes in obese patients. An increasing number of patients are 
      categorized as morbidly obese (body mass index [BMI] >/= 40 kg/m2). Perioperative 
      and patient-reported outcomes (PROs) are lacking in this patient population. 
      METHODS: The authors retrospectively reviewed a prospectively collected database 
      of all morbidly obese and non-obese patients that underwent MiTLIF between 2015 
      and 2018 for degenerative conditions who had minimum 1-year follow-up for outcome 
      assessment. An inverse propensity/probability of treatment weighting was utilized 
      to create a synthetic weighted sample in which covariates were independent of 
      obesity designation to adjust for imbalance between groups. Generalized 
      estimating equations (GEE) was used to estimate the association of morbid obesity 
      and complications and 1-year PROs. RESULTS: A total of 292 patients were analyzed 
      with 234 non-obese patients and 58 morbidly obese patients. Multivariate analysis 
      failed to demonstrate any association between morbid obesity and achieving 
      minimal clinically important difference (MCID) for Oswestry disability index 
      (ODI), visual analog scale (VAS), or short form-12 (SF-12) physical component 
      score. However, morbid obesity was associated with significant decrease in odds 
      of achieving MCID for SF-12 mental component score (P = 0.001). Increased surgery 
      duration was significantly associated with morbid obesity (P = 0.001). Morbid 
      obesity exhibited no statistically significant association with postoperative 
      complications, readmission, pseudarthrosis, or adjacent segment disease (ASD). 
      CONCLUSION: Morbidly obese patients who undergo MiTLIF can achieve meaningful 
      clinical improvement comparable to nonobese patients. Morbid obesity was 
      associated with longer surgical times but was not associated with postoperative 
      complications, readmission, or ASD.Level of Evidence: 3.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Claus, Chad F
AU  - Claus CF
AD  - Division of Neurosurgery, Ascension Providence Hospital, College of Human 
      Medicine, Michigan State University, Southfield, MI.
FAU - Lawless, Michael
AU  - Lawless M
FAU - Lytle, Evan
AU  - Lytle E
FAU - Tong, Doris
AU  - Tong D
FAU - Bahoura, Matthew
AU  - Bahoura M
FAU - Garmo, Lucas
AU  - Garmo L
FAU - Gabrail, Joseph
AU  - Gabrail J
FAU - Bono, Peter
AU  - Bono P
FAU - Kelkar, Prashant
AU  - Kelkar P
FAU - Richards, Boyd
AU  - Richards B
FAU - Carr, Daniel A
AU  - Carr DA
FAU - Houseman, Clifford
AU  - Houseman C
FAU - Soo, Teck M
AU  - Soo TM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Humans
MH  - Lumbar Vertebrae/surgery
MH  - *Obesity, Morbid/complications/surgery
MH  - Patient Readmission
MH  - Patient Reported Outcome Measures
MH  - Propensity Score
MH  - Retrospective Studies
MH  - *Spinal Fusion/adverse effects
MH  - Treatment Outcome
EDAT- 2021/09/25 06:00
MHDA- 2021/09/29 06:00
CRDT- 2021/09/24 17:15
PHST- 2021/09/24 17:15 [entrez]
PHST- 2021/09/25 06:00 [pubmed]
PHST- 2021/09/29 06:00 [medline]
AID - 00007632-202110150-00006 [pii]
AID - 10.1097/BRS.0000000000004059 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2021 Oct 15;46(20):1394-1401. doi: 
      10.1097/BRS.0000000000004059.