Does minimally invasive spine surgery improve outcomes in the obese population? A retrospective review of 1442 degenerative lumbar spine surgeries.
Does minimally invasive spine surgery improve outcomes in the obese population? A retrospective review of 1442 degenerative lumbar spine surgeries.
- 2021
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: Obese patients have poorer outcomes after posterior lumbar MIS when compared with nonobese patients. The use of an MIS technique can be of benefit, as it decreased EBL, operative time, LOS, and SSIs for posterior decompression with or without instrumented fusion in obese patients. METHODS: A retrospective review of all consecutive patients who underwent posterior lumbar surgery from 2013 to 2016 at a single institution was performed. The primary outcome measure was postoperative complications. Secondary outcome measures included estimated blood loss (EBL), operative time, the need for revision, and hospital length of stay (LOS); readmission and disposition were also reviewed. Obese patients who underwent MIS were compared with those who underwent an open approach. Additionally, obese patients who underwent an MIS approach were compared with nonobese patients. Bivariate and multivariate analyses were carried out between the groups. OBJECTIVE: The effect of obesity on outcomes in minimally invasive surgery (MIS) approaches to posterior lumbar surgery is not well characterized. The authors aimed to determine if there was a difference in operative variables and complication rates in obese patients who underwent MIS versus open approaches in posterior spinal surgery, as well as between obese and nonobese patients undergoing MIS approaches. RESULTS: In total, 423 obese patients (57.0% decompression and 43.0% fusion) underwent posterior lumbar MIS. When compared with 229 obese patients (56.8% decompression and 43.2% fusion) who underwent an open approach, patients in both the obese and nonobese groups who underwent MIS experienced significantly decreased EBL, LOS, operative time, and surgical site infections (SSIs). Of the nonobese patients, 538 (58.4% decompression and 41.6% fusion) underwent MIS procedures. When compared with nonobese patients, obese patients who underwent MIS procedures had significantly increased LOS, EBL, operative time, revision rates, complications, and readmissions in the decompression group. In the fusion group, only LOS and disposition were significantly different.
English
1547-5646
10.3171/2021.1.SPINE201785 [doi] 2021.1.SPINE201785 [pii]
*Lumbar Vertebrae/su [Surgery]
*Lumbosacral Region/su [Surgery]
*Minimally Invasive Surgical Procedures
*Neurosurgical Procedures
Decompression, Surgical/ae [Adverse Effects]
Decompression, Surgical/mt [Methods]
Female
Humans
Length of Stay/sn [Statistics & Numerical Data]
Male
Middle Aged
Minimally Invasive Surgical Procedures/ae [Adverse Effects]
Minimally Invasive Surgical Procedures/mt [Methods]
Reoperation
Spinal Fusion/mt [Methods]
Treatment Outcome
MedStar Washington Hospital Center
Neurosurgery Residency
Journal Article
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: Obese patients have poorer outcomes after posterior lumbar MIS when compared with nonobese patients. The use of an MIS technique can be of benefit, as it decreased EBL, operative time, LOS, and SSIs for posterior decompression with or without instrumented fusion in obese patients. METHODS: A retrospective review of all consecutive patients who underwent posterior lumbar surgery from 2013 to 2016 at a single institution was performed. The primary outcome measure was postoperative complications. Secondary outcome measures included estimated blood loss (EBL), operative time, the need for revision, and hospital length of stay (LOS); readmission and disposition were also reviewed. Obese patients who underwent MIS were compared with those who underwent an open approach. Additionally, obese patients who underwent an MIS approach were compared with nonobese patients. Bivariate and multivariate analyses were carried out between the groups. OBJECTIVE: The effect of obesity on outcomes in minimally invasive surgery (MIS) approaches to posterior lumbar surgery is not well characterized. The authors aimed to determine if there was a difference in operative variables and complication rates in obese patients who underwent MIS versus open approaches in posterior spinal surgery, as well as between obese and nonobese patients undergoing MIS approaches. RESULTS: In total, 423 obese patients (57.0% decompression and 43.0% fusion) underwent posterior lumbar MIS. When compared with 229 obese patients (56.8% decompression and 43.2% fusion) who underwent an open approach, patients in both the obese and nonobese groups who underwent MIS experienced significantly decreased EBL, LOS, operative time, and surgical site infections (SSIs). Of the nonobese patients, 538 (58.4% decompression and 41.6% fusion) underwent MIS procedures. When compared with nonobese patients, obese patients who underwent MIS procedures had significantly increased LOS, EBL, operative time, revision rates, complications, and readmissions in the decompression group. In the fusion group, only LOS and disposition were significantly different.
English
1547-5646
10.3171/2021.1.SPINE201785 [doi] 2021.1.SPINE201785 [pii]
*Lumbar Vertebrae/su [Surgery]
*Lumbosacral Region/su [Surgery]
*Minimally Invasive Surgical Procedures
*Neurosurgical Procedures
Decompression, Surgical/ae [Adverse Effects]
Decompression, Surgical/mt [Methods]
Female
Humans
Length of Stay/sn [Statistics & Numerical Data]
Male
Middle Aged
Minimally Invasive Surgical Procedures/ae [Adverse Effects]
Minimally Invasive Surgical Procedures/mt [Methods]
Reoperation
Spinal Fusion/mt [Methods]
Treatment Outcome
MedStar Washington Hospital Center
Neurosurgery Residency
Journal Article