title: Does Obesity Correlate With Worse Patient-Reported Outcomes Following Elective Anterior Cervical Discectomy and Fusion?
abstract: Studies have investigated the impact of obesity in thoracolumbar surgery; however, the effect of obesity on patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF) is unknown.
  
  
  
  To examine the relationship between obesity and PROs following elective ACDF.
  
  
  
  Consecutive patients undergoing ACDF for degenerative conditions were evaluated. Patients were divided into groups with a body mass index ≥35. The EuroQol-5D, Short-Form 12 (SF-12), modified Japanese Orthopaedic Association score, and Neck Disability Index were used. Correlations between PROs and obesity were calculated at baseline and 1 year.
  
  
  
  A total of 299 patients were included, with 80 obese (27%) and 219 nonobese (73%). patients At baseline, obesity was associated with worse myelopathy (modified Japanese Orthopaedic Association score: 10.7 vs 12.2, P = .01), general physical health (SF-12 physical component scale score: 28.7 vs 31.8, P = .02), and general mental health (SF-12 mental component scale score: 38.9 vs 42.3, P = .04). All PROs improved significantly following surgery in both groups. There was no difference in absolute scores and change scores for any PRO at 12 months following surgery. Furthermore, there was no difference in the percentage of patients achieving a minimal clinically important difference for the Neck Disability Index (52% vs 56%, P = .51) and no difference in patient satisfaction (85% vs 85%, P = .85) between groups.
  
  
  
  Obesity was not associated with less improvement in PROs following ACDF. There was no difference in the proportion of patients satisfied with surgery and those achieving a minimal clinically important difference across all PROs. Obese patients may therefore achieve meaningful improvement following elective ACDF.
  
  
  
  ACDF, anterior cervical discectomy and fusionBMI, body mass indexEQ-5D, EuroQol-5DMCID, minimal clinically important differenceMCS, mental component scalemJOA, modified Japanese Orthopaedic AssociationNDI, Neck Disability IndexNRS, Numerical Rating ScalePCS, physical component scalePROs, patient-reported outcomesSF-12, Short Form 12.
authors.affiliation: *Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; ‡Vanderbilt University School of Medicine, Nashville, Tennessee; §Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
authors.forename: John A
authors.initials: JA
authors.lastname: Sielatycki
authors.forename: Silky
authors.initials: S
authors.lastname: Chotai
authors.forename: Harrison
authors.initials: H
authors.lastname: Kay
authors.forename: David
authors.initials: D
authors.lastname: Stonko
authors.forename: Matthew
authors.initials: M
authors.lastname: McGirt
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002574:Cervical Vertebrae / Q000601:surgery*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000601:surgery; D010147:Pain Measurement; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D012042:Registries; D013118:Spinal Cord Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome