BMI and Patient-Reported Outcomes Following Spinal Surgery: A Retrospective Review.

Area of Science:

• Spine Surgery
• Orthopedics
• Patient Outcomes

Background:

• Increasing body mass index (BMI) correlates with higher risks of complications after spinal fusion surgery.
• Long-term patient-reported outcome measures (PROMs) in relation to BMI after spinal fusion are not well-investigated.

Purpose of the Study:

• To evaluate the association between patient BMI and long-term PROMs following spinal fusion surgery.
• To determine if BMI is an independent predictor of clinically meaningful improvement after spinal fusion.

Main Methods:

• Retrospective analysis of 1,471 patients undergoing spinal fusion (2016-2024).
• Extracted demographic, surgical, and PROM data from medical records.
• Utilized multivariable linear regression to control for confounders.

Main Results:

• Obese patients were younger with more comorbidities (diabetes, hypertension).
• Elevated BMI correlated with worse mean scores for disability (ODI) and pain (VAS Neck, VAS Back, PROMIS Pain) at 12 months.
• Obesity independently predicted worse ODI, VAS Arm, and VAS Leg scores; overweight status predicted worse VAS Leg scores.
• BMI was not a consistent predictor of achieving minimal clinically important differences (MCID) across PROMs.
• Time from surgery, sex, operative duration, levels fused, and revision status were stronger predictors of outcomes than BMI.

Conclusions:

• Elevated BMI is associated with worse pain and disability post-spinal fusion but not consistently with clinically meaningful improvement.
• Recovery is more influenced by surgical factors and time than BMI alone.
• Individualized perioperative optimization is recommended, and BMI should not solely guide postoperative expectations.