title: Increased Body Mass Index Negatively Affects Patient Satisfaction After a Posterior Fusion and Instrumentation for Adolescent Idiopathic Scoliosis.
abstract: METHODS
  Retrospective.
  
  
  BACKGROUND
  Previous studies have reported the correlation of body mass index (BMI) with non-spine surgical outcomes; however, only a few reviewed the correlation of BMI to outcomes after spine surgery.
  
  
  OBJECTIVE
  To review the influence of preoperative BMI on the follow-up clinical and functional outcomes after posterior-only fusion (PSF) and instrumentation for adolescent idiopathic scoliosis in a larger patient cohort.
  
  
  METHODS
  Retrospective review of a consecutive series of patients treated with PSF for adolescent idiopathic scoliosis from 2002 to 2009 at a single institution. There were 3 categories: underweight (UW), normal weight (NML), and overweight (OW). Percent correction of the major curve was collected at 2 years postoperatively and patient outcome scores were analyzed preoperatively and at 2 years postoperatively. Differences between groups were analyzed using analysis of variance, with p < .05.
  
  
  RESULTS
  A total of 459 patients at an average age of 15.0 years (range, 10.0-21.3 years) treated with PSF instrumentation were included. At 2 years, all groups achieved and maintained equal percent correction with no differences between groups. Regarding preoperative Scoliosis Research Society (SRS) outcome scores, OW patients reported more pain than NML (p = .002) and UW patients (p < .001) despite less reported activity than for the NML (p = .033) and UW groups (p = .005). The total SRS score was also lower in the OW patients compared with NML (p = .009) and UW patients (p = .002). At 2 years, the OW group reported more pain than the UW (p = .031) and NML groups (p = .018), lower mental scores (p = .011) and lower SRS total scores (p = .005) than the NML group.
  
  
  CONCLUSIONS
  At follow-up, preoperative overweight adolescents reported more pain and lower mental, activity, and appearance domain scores after surgery than UW and NML patients despite equal percent curve correction. This information may help the surgeon with preoperative counseling of OW patients by stressing that their own assessment of outcome is influenced by BMI, which may help promote a healthy weight management program in this patient group.
authors.affiliation: Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA.
authors.forename: Adriana
authors.initials: A
authors.lastname: De La Rocha
authors.affiliation: Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: McClung
authors.affiliation: Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA. Electronic address: dan.sucato@tsrh.org.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sucato
keywords: Adolescent idiopathic scoliosis; Body mass index; Patient self-reported outcomes