Morbidly Obese Patients Have Similar Clinical Outcomes and Recovery Kinetics After Minimally Invasive Decompression

Pratyush Shahi; Tejas Subramanian; Sumedha Singh; Kasra Araghi; Tomoyuki Asada; Maximilian Korsun; Nishtha Singh; Olivia Tuma; Chad Simon; Avani Vaishnav; Eric Mai; Joshua Zhang; Cole Kwas; Myles Allen; Eric Kim; Annika Heuer; Evan Sheha; James Dowdell; Sheeraz Qureshi; Sravisht Iyer

doi:10.1097/BRS.0000000000005045

Morbidly Obese Patients Have Similar Clinical Outcomes and Recovery Kinetics After Minimally Invasive Decompression

Spine (Phila Pa 1976). 2024 May 17. doi: 10.1097/BRS.0000000000005045. Online ahead of print.

Authors

Pratyush Shahi¹, Tejas Subramanian^{1

2}, Sumedha Singh¹, Kasra Araghi¹, Tomoyuki Asada¹, Maximilian Korsun¹, Nishtha Singh¹, Olivia Tuma¹, Chad Simon¹, Avani Vaishnav¹, Eric Mai¹, Joshua Zhang¹, Cole Kwas¹, Myles Allen¹, Eric Kim¹, Annika Heuer¹, Evan Sheha¹, James Dowdell¹, Sheeraz Qureshi¹, Sravisht Iyer¹

Affiliations

¹ Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA.
² Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA Institute where the work was performed: Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA.

PMID: 38756000
DOI: 10.1097/BRS.0000000000005045

Abstract

Study design: Retrospective cohort.

Objective: To study the impact of class 2/3 obesity (body mass index, BMI >35) on outcomes following minimally invasive decompression.

Summary of background data: No previous study has analyzed the impact of class 2/3 obesity on outcomes following minimally invasive decompression.

Methods: Patients who underwent primary minimally invasive decompression were divided into 4 cohorts based on their BMI: normal (BMI 18.5 to <25), overweight (25 to <30), class 1 obesity (30 to <35), and class 2/3 obesity (BMI >35). Outcome measures were: 1) intraoperative variables: operative time, estimated blood loss (EBL); 2) patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 3) global rating change (GRC), minimal clinically important difference (MCID), and patient acceptable symptom state (PASS) achievement rates; 4) return to activities; and 5) complication and reoperation rates.

Results: 838 patients were included (226 normal, 357 overweight, 179 class 1 obesity, 76 class 2/3 obesity). Class 1 and 2/3 obesity groups had significantly greater operative times compared to the other groups. Class 2/3 obesity group had worse ODI, VAS back and SF-12 PCS preoperatively, worse ODI, VAS back, VAS leg and SF-12 PCS at <6 months, and worse ODI and SF-12 PCS at >6 months. However, they had significant improvement in all PROMs at both postoperative timepoints and the magnitude of improvement was similar to other groups. No significant differences were found in MCID and PASS achievement rates, likelihood of betterment on the GRC scale, return to activities, and complication/reoperation rates.

Conclusions: Class 2/3 obese patients have worse PROMs pre- and post-operatively. However, they show similar improvement in PROMs, MCID and PASS achievement rates, likelihood of betterment, recovery kinetics, and complication/reoperation rates as other BMI groups following minimally invasive decompression.