Introduction: The influence of obesity on spine surgery outcomes is highly controversial with a current clinical equipoise. Several studies suggest higher perioperative morbidity with obesity while some studies suggest otherwise. To address this gap in the literature, we conducted a systematic review and meta-analysis with the objective of better defining the impact of obesity on outcomes following lumbar spine surgery.
Methods: Literature search was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for article screening and inclusion. Strength of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group system. Surgical outcomes such as blood loss, operative time, length of stay, complication and reoperation rates and functional outcomes represented by the change in ODI and VAS-BP were compared between obese and non-obese patients
Results: A total of 32 studies with 23,530 patients were analyzed. Obese patients had slightly higher surgical blood loss (Mean Difference [MD]: 49.99 ml, CI: 23.69-76.29, p-value< .001, I2=86%) and longer operative times (MD: 16.66 min, CI: 9.27-24.05, p-value< .001, I2=92%), but similar length of stay as compared to non-obese patients. Higher complication (OR=1.32, C.I.=1.13-1.54, p=0.01, I2=39%) and reoperation rates(OR=1.40, C.I.=1.19-1.64, p<0.001, I2=20) were observed in obese patients. The differences, however, were not significant for obese patients undergoing MIS surgery. Functional outcomes (change in ODI and VAS-BP) were similar between the two groups. Overall confidence in GRADE estimates was either low or very low for all outcomes.
Conclusions: Obesity might be linked to higher adverse events following lumbar spine surgery. Minimally invasive spine surgery, however, might offer comparable outcomes between obese and non-obese patients
Patient Care: This papers summarizes impact of BMI following lumbar spine surgery. Outcomes are stratified between MIS and open surgery. This might help providers in performing better risk stratification and choose optimal surgical technique in obese patients.
Learning Objectives: 1)Characterize outcomes following elective lumbar spine surgery in obese and non obese patients
2)Characterize outcomes following MIS vs open surgery in obese and non obese patients
3)Assess strength of evidence using GRADE working group system