• R Kirk Owens, Mladen Djurasovic, Ikemefuna Onyekwelu, Kelly R Bratcher, Katlyn E McGraw, and Leah Y Carreon.
• Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St, 1st Floor ACB, Louisville, KY 40202, USA.
• Spine J. 2016 Oct 1; 16 (10): 1178-1183.

Background ContextObesity is a growing problem in health care. Studies have demonstrated similar functional outcomes but higher complication rates after spine surgery in obese patients.PurposeThis study aimed to compare patient-reported outcomes and revision rates 5 years after instrumented posterior lumbar fusion between normal, overweight, and obese patients.Study DesignPropensity matched case control.Patient SamplePatients who had posterior instrumented lumbar spinal fusion from 2001 to 2008 from a single spine specialty center with complete preoperative and 5-year postoperative outcome measures were identified.Outcome MeasuresOswestry Disability Index (ODI), Back Pain (0-10) and Leg Pain (0-10) Numeric Rating Scales, and Short Form-36 Physical Composite Summary Scores (SF-36 PCS).MethodsThree comparison groups, one with body mass index (BMI) ≥20-25 kg/m2 (normal), another with ≥25-<30 kg/m2 (overweight), and another with ≥30-40 kg/m2 (obese) were created using propensity matching techniques based on demographics, baseline clinical outcome measures, and surgical characteristics. Five-year postoperative outcome measures and revision rates in the three groups were compared. One-way analysis of variance was used to compare continuous variables, and Fisher exact test was used to compare categorical variables between the groups. Significance was set at p<.01.ResultsThere were 82 cases matched in each cohort. Estimated blood loss (440 cc vs. 702 cc vs. 798 cc, p=.000) and operative time (234 minutes vs. 263 minutes vs. 275 minutes, p=.003) were significantly greater in the overweight and obese patients. Improvements in ODI (14.2 vs. 9.6 vs. 10.4, p=.226), SF-36 PCS (5.9 vs. 2.9 vs. 3.5, p=.361), back pain (3.0 vs. 2.0 vs. 2.1, p=.028), and leg pain (3.0 vs. 2.3 vs. 2.3, p=.311) scores were similar among the groups. Revision rates (14 vs. 15 vs. 13, p=.917), and time between index and revision surgery (p=.990) were similar among the three groups as well.ConclusionWhen considering a subset of patient-reported outcomes and revision surgery after 5 years, patients with an elevated BMI >25 at baseline did not appear to have worse outcomes than those with a normal BMI of 20-25 when undergoing posterior lumbar fusion surgery. Obesity should not be considered a contraindication to surgery in patients with appropriate surgical indications.Copyright © 2016 Elsevier Inc. All rights reserved.

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