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The Effects of Obesity Among Patients Undergoing Surgery for Degenerative Lumbar Conditions: An Observational Study
Heidi Chan1, Fred Nicholls1, Ganesh Swamy1
1University of Calgary, Calgary, Alberta, Canada.
Study Design:
Prospective cohort study.
Objective:
Our primary objective was to determine the effects of all classes of obesity (BMI ≥30) on patient-reported disability at one year of follow-up among patients undergoing surgery for degenerative lumbar conditions, with particular attention given to the effects of severe obesity (BMI ≥40). Secondary objectives were to determine effects on health-related quality of life, back pain, leg pain, and adverse events.
Summary Of Background Data:
The importance of obesity among patients undergoing spine surgery has been well-established, but effects according to severity of obesity remain poorly understood.
Methods:
Patients were prospectively enrolled in the Canadian Spine Outcomes and Research Network between 2015 and 2024. We used logistic regression and propensity score matching to compare outcomes while adjusting for potential confounders.
Results:
Among 6,242 patients, 2309 (37%) had obesity including 1448 (23%) with Class I (BMI 30 to <35), 571 (9%) with Class II (BMI 35 to <40) and 290 (5%) with Class III (BMI ≥40, "severe" obesity). Patients with any class of obesity were significantly less likely to achieve the Minimum Clinically Important Difference (MCID) for the Oswestry Disability Index, and the effect most pronounced for those with Class III obesity (Odds Ratio (OR) 0.83, 95% CI 0.76 to 0.90, P<0.01). Rates of incidental durotomy (OR 1.20, 95% CI 1.05 to 1.38, P<0.01), surgical site infection (OR 1.49, 95% CI 1.25 to 1.78, P<0.01), and wound dehiscence (OR 2.21, 95% CI 1.59 to 3.07, P<0.01) were all significantly higher among patients with Class III obesity.
Conclusions:
Patients with obesity were less likely to experience improvement of disability after surgery for degenerative lumbar conditions and severe obesity was particularly associated with greater odds adverse events. These findings inform shared clinical decision-making and suggest that obesity management prior to surgery may be of benefit.