Do Obese Patients Undergoing Surgery for Grade 1 Spondylolisthesis Have Worse outcomes at 5 years Followup? A QOD Study.

Friday, May 3, 2024

Presenting Author(s)

VA

Vardhaan S. Ambati, MS

Medical Student
University of California San Francisco
San Jose, California, United States

Co-Author(s)

Nima Alan, MD

Neurosurgeon
UCSF
Phoenix, Arizona, United States
Anthony L. Asher, MD

President AANS, Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, North Carolina, United States
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, Minnesota, United States
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
Regis William Haid, Jr., MD

Neurosurgeon
Atlanta Brain and Spine
Atlanta, Georgia, United States
John Knightly, MD

Director of Neurosurgery
Atlantic Neurosurgical Specialists
Morristown, New Jersey, United States

Submitter(s)

VL

Vivian P. Le, MPH

Clinical Research Coordinator Supervisor
University of California, San Francisco

Co-Author(s)

SM

Scott Meyer, MD

Neurosurgeon
Altair Health
Minneapolis, Minnesota, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Arati Patel, MD

Resident Physician
Department of Neurological Surgery, University of California, San Francisco
San Francisco, California, United States
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, VA, US
JS

Jonathan R. Slotkin, MD

Surgeon
Geisinger Health
Danville, Pennsylvania, United States
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, New York, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US
Timothy J. Yee, MD

Fellow
University of California San Francisco
San Francisco, CA, US
Samer G. Zammar, MD, MBA, MPH (he/him/his)

Fellow
University of California San Francisco
San Francisco, CA, US

Introduction: Obesity is a known risk factor for poor surgical outcomes. However the long-term effects of increased BMI on surgical outcomes are not well documented for patients who undergo surgery for low-grade (grade 1) lumbar spondylolisthesis.

Methods: Prospectively collected data from the Quality Outcomes Database’s 12-highest enrolling sites were used to compare patients (BMI < 35 vs BMI≥35) who underwent surgery for low-grade spondylolisthesis.

Results: In total, 608 patients (57.6% female) were included with an 80% 5-year follow up rate. Patients with BMI≥35 (N=130; 21.4%) were compared to patients with BMI < 35 (N=478; 78.6%). BMI≥35 patients were more likely to have surgery at younger ages (58.5±11.4 vs 63.2±12.0,p < 0.001), present with dominant symptom of both back and leg pain (53.8% vs 37.0%,p=0.002), and require assistance for ambulation (20.8% vs 9.2%,p < 0.001). Further, patients with BMI≥35 had worse patient reported outcomes (PROs) at baseline including numerical rating scale leg (NRS-LP) (7.1±2.6 vs 6.4±2.9,p < 0.001) and back (NRS-BP) (7.6±2.3 vs 6.5±2.8,p < 0.001) pain, and disability (ODI: 53.7±15.7 vs 44.8±17.0,p < 0.001). Patients with BMI≥35 were more likely to require fusion (85.4% vs 74.7%,p=0.01). They also experienced higher blood loss (262.9±259.6 vs 165.5±175.8 ml,p < 0.001), longer hospitalization (3.2±1.5 vs 2.6±1.8 days, p< 0.001), and were more likely to have non-routine discharge (17.1% vs 7.4%,p < 0.001). At 5-years postoperatively, the BMI≥35 cohort reported significantly worse NRS-LP (3.7±3.4 vs 2.3±2.9,p < 0.001), NRS-BP (4.3±3.3 vs 3.3±3.0,p < 0.001), and disability (ODI: 33.1±21.1 vs 21.6±19.0,p < 0.001). However, both cohorts expressed similar rates of satisfaction on NASS questionnaire. On multivariate analysis, while BMI ≥35 did not predict minimal clinically important differences MCID for NRS-BP or ODI, BMI ≥35 resulted in 15% lower odds of achieving MCID for NRS-LP (p=0.007).

Conclusion : At 5-years postoperatively, both BMI < 35 and BMI≥35 cohorts achieve similar rates of satisfaction and MCID for back pain and ODI. However, BMI>35 patients achieve lower rates of MCID for leg pain compared to the BMI < 35 cohort.