title: Is obesity associated with worse patient-reported outcomes following lumbar surgery for degenerative conditions?
abstract: To investigate whether obesity is associated with worse patient-reported outcomes following surgery for degenerative lumbar conditions.
  
  
  
  We evaluated consecutive patients undergoing elective lumbar laminectomy or laminectomy with fusion for degenerative lumbar conditions. The Oswestry Disability Index (ODI), EuroQol-5D (EQ-5D), Short-Form 12 (SF-12), and NASS patient satisfaction were utilized. Chi-square tests and student t test assessed the association of obesity with PROs. Multivariate regression controlled for age, sex, smoking status, anxiety, depression, revision, preoperative narcotic use, payer status, and diabetes.
  
  
  
  A total of 602 patients were included. All PROs improved significantly in both groups. BMI ≥35 was associated with increased ODI at baseline (50.6 vs. 47.2 %, p = 0.012) and 12 months (30.5 vs. 25.7 %, p = 0.005). There was no difference in ODI change scores (21.2 vs. 19.4 %, p = 0.32). With multivariate analysis, BMI ≥35 was not predictive of worse ODI at 12 months (correlation coefficient 1.23, 95 % CI -0.225 to 2.676.) There was no significant difference between groups in percentage of patients achieving the minimum clinically important difference for ODI (59.6 vs. 64 %, p = 0.46) or patient satisfaction (80.5 vs. 78.9 %, p = 0.63).
  
  
  
  Body mass index ≥35 is associated with worse baseline and 12-month PROs, however, there was no difference in change scores across BMI groups. Controlling for important co-variables, BMI greater than 35 was not an independent predictor of worse PROs at 12 months.
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East-South Tower, Suite 4200, Nashville, TN, 37232, USA.
authors.forename: J Alex
authors.initials: JA
authors.lastname: Sielatycki
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East-South Tower, Suite 4200, Nashville, TN, 37232, USA.
authors.forename: Silky
authors.initials: S
authors.lastname: Chotai
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Stonko
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Wick
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Harrison
authors.initials: H
authors.lastname: Kay
authors.affiliation: Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East-South Tower, Suite 4200, Nashville, TN, 37232, USA. clintondevin@gmail.com.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D015992:Body Mass Index; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D012042:Registries; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000601:surgery; D013168:Spondylolisthesis / Q000601:surgery; D014481:United States / Q000453:epidemiology
keywords: Lumbar surgery; Obesity; Outcomes; Patient-reported outcomes