The Impact of Obesity on Postoperative and Perioperative Outcomes in Lumbar Spine Surgery, a Systematic Review and Meta Analysis.

Abstract

Background context: Obesity is increasingly prevalent globally and is associated with various health issues, including spine-related disorders. Previous studies have shown mixed results regarding the impact of obesity on spine surgery outcomes.

Purpose: This meta-analysis aims to evaluate the effects of obesity on perioperative and post-operative outcomes in spine surgery patients.

Study design/setting: We performed a systematic review and meta-analysis of prospective and retrospective studies comparing outcomes between obese and non-obese spine surgery patients.

Patient sample: The meta-analysis included 35,639 patients, of which 9,369 were obese (BMI ≥ 30 kg/m²) and 26,270 were non-obese (BMI < 30 kg/m²).

Outcome measures: Primary outcomes included patient-reported outcome measures (PROMs) such as the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for leg and back pain. Secondary outcomes involved perioperative measures like estimated blood loss (EBL), operative time, and length of stay (LOS), as well as complication and reoperation rates.

Methods: Following PRISMA guidelines, four databases were searched for relevant studies. The quality of included studies was assessed using the Cochrane Risk of Bias tool. Mean differences were used to quantify the differences in PROMs and perioperative outcomes. Odds ratios were used to analyze differences in complication rates.

Results: Obese patients had similar PROMs compared to non-obese patients, with differences not exceeding the minimal clinically important difference (MCID). However, obese patients experienced longer operative times, greater EBL, and extended hospital stays. They also had higher rates of postoperative complications such as dural tears, infections, and reoperations.

Conclusions: While obesity is associated with certain perioperative challenges, the postoperative recovery in terms of pain and disability appears comparable between obese and non-obese patients. Spine surgeons should be aware of the increased perioperative risks but can reassure obese patients of similar long-term outcomes post-surgery.