Severe obesity and metabolic syndrome are associated with higher complications following endoscopic lumbar...

Endoscopic lumbar decompression is increasingly used to treat lumbar spinal stenosis, but the impact of obesity on short-term postoperative outcomes remains unclear. This study evaluated the association of BMI and metabolic syndrome with 30-day complications and reoperation following endoscopic lumbar decompression.

A national database was queried for patients undergoing endoscopic lumbar decompression between 2017-2023. Patients were stratified by BMI category (normal, overweight [25 to <30], class I obesity [30 to <35], class II/III obesity [≥35]). Metabolic syndrome was defined as BMI ≥ 30 with concurrent diabetes mellitus and hypertension. Outcomes included 30-day readmission, reoperation, and composite morbidity, including surgical site infection (SSI), urinary tract infection (UTI), transfusion, pneumonia, or sepsis. Categorical variables were compared using chi-square or Fisher exact tests; continuous variables were analyzed using one-way ANOVA.

A total of 398 patients were included (normal n = 70, overweight n = 116, class I obesity n = 137, class II/III obesity n = 75). BMI ≥ 30 was not associated with differences in 30-day readmission, reoperation, or overall morbidity. In contrast, BMI ≥ 35 was associated with higher 30-day morbidity (6.7% vs 1.2%, p = 0.014), higher SSI (4.0% vs 0.6%, p = 0.048), and higher UTI rates (2.7% vs 0.3%, p = 0.033). Metabolic syndrome was associated with increased readmission (9.7% vs 2.7%, p = 0.037) and morbidity (9.7% vs 1.6%, p = 0.026).

Endoscopic lumbar decompression demonstrated low overall 30-day event rates across BMI strata. Class I obesity was not associated with higher short-term adverse event rates; however, exploratory threshold analyses identified higher morbidity among patients with BMI ≥ 35 and metabolic syndrome, driven primarily by wound complications and UTI.