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  • Does Obesity Correlate with Worse Patient-Reported Outcomes Following Cervical Surgery for Degenerative Conditions?

    Final Number:

    John Alexander Sielatycki MD; Silky Chotai MD; Joseph Wick; David P Stonko; Harrison F. Kay; Clinton J. Devin MD; Matthew J. McGirt MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Numerous studies have investigated the impact of obesity in thoracolumbar surgery, however the effect of obesity on patient-reported outcomes (PROs) in cervical surgery has not been established. The purpose of this study was to investigate the possible correlation between obesity and patient-reported outcomes following surgery for degenerative cervical conditions.

    Methods: Patients undergoing elective anterior cervical discectomy and fusion were evaluated. Follow up of at least 12 months was required. Patients were excluded for trauma, tumor, infection, urgent/emergent surgery, deformity, and pseudarthrosis. The EuroQol-5D (EQ-5D), Short Form-12 (SF-12), modified Japanese Orthopaedic Association (mJOAS) score, Neck Disability Index (NDI), and NASS patient satisfaction were utilized. Patients were defined as “obese” for BMI = 35 based on the World Health Organization definition of class II obesity. Chi-square tests assessed the association of obesity with disability, as well as percent achieving minimum clinically important difference (MCID) for NDI and satisfaction at 12 months.

    Results: A total of 299 patients were included, with 80 (27%) obese, and 219 (73%) non-obese. All PROs improved significantly after surgery in both groups. There was no difference in pre- to post-operative change scores for any PRO measure, including NDI (18.2 vs. 19.1, p = 0.67) and SF-12 PCS (10.2 vs. 10.4, p = 0.92). At 12 months there was no difference in percent of patients achieving MCID for NDI (52% vs 56%, p = 0.51), and no difference in patient satisfaction (85% vs. 85%, p = 0.85).

    Conclusions: In this analysis of patients undergoing elective cervical surgery, BMI = 35 is associated with worse baseline and 12-month PROs, however no differences in change scores were observed across BMI groups for all PROs. There was no difference in percent of patients achieving MCID in NDI or satisfaction at 12 months. Obese patients may therefore achieve meaningful improvement following surgery for degenerative cervical conditions.

    Patient Care: This study provides useful information for surgeons in treating obese patients with cervical pathology and for improving the informed consent and decision making process.

    Learning Objectives: At the end of this session, participants should be able to 1) discuss the impact of obesity on patient-reported outcomes following ACDF. 2) Apply this knowledge to the process of informed consent and surgical decision making.


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