Sielatycki J Alex, Chotai Silky, Stonko David, Wick Joseph, Kay Harrison, McGirt Matthew J, Devin Clinton J
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East-South Tower, Suite 4200, Nashville, TN, 37232, USA.
Vanderbilt University School of Medicine, Nashville, TN, USA.
Eur Spine J. 2016 May;25(5):1627-1633. doi: 10.1007/s00586-016-4460-1. Epub 2016 Mar 5.
To investigate whether obesity is associated with worse patient-reported outcomes following surgery for degenerative lumbar conditions.
We evaluated consecutive patients undergoing elective lumbar laminectomy or laminectomy with fusion for degenerative lumbar conditions. The Oswestry Disability Index (ODI), EuroQol-5D (EQ-5D), Short-Form 12 (SF-12), and NASS patient satisfaction were utilized. Chi-square tests and student t test assessed the association of obesity with PROs. Multivariate regression controlled for age, sex, smoking status, anxiety, depression, revision, preoperative narcotic use, payer status, and diabetes.
A total of 602 patients were included. All PROs improved significantly in both groups. BMI ≥35 was associated with increased ODI at baseline (50.6 vs. 47.2 %, p = 0.012) and 12 months (30.5 vs. 25.7 %, p = 0.005). There was no difference in ODI change scores (21.2 vs. 19.4 %, p = 0.32). With multivariate analysis, BMI ≥35 was not predictive of worse ODI at 12 months (correlation coefficient 1.23, 95 % CI -0.225 to 2.676.) There was no significant difference between groups in percentage of patients achieving the minimum clinically important difference for ODI (59.6 vs. 64 %, p = 0.46) or patient satisfaction (80.5 vs. 78.9 %, p = 0.63).
Body mass index ≥35 is associated with worse baseline and 12-month PROs, however, there was no difference in change scores across BMI groups. Controlling for important co-variables, BMI greater than 35 was not an independent predictor of worse PROs at 12 months.
研究肥胖是否与退行性腰椎疾病手术后患者报告的预后较差相关。
我们评估了因退行性腰椎疾病接受选择性腰椎椎板切除术或椎板切除融合术的连续患者。使用了奥斯威斯利功能障碍指数（ODI）、欧洲五维健康量表（EQ-5D）、简明健康调查量表（SF-12）和北美脊柱外科学会（NASS）患者满意度。卡方检验和学生t检验评估肥胖与患者报告结局（PROs）之间的关联。多变量回归分析控制了年龄、性别、吸烟状况、焦虑、抑郁、翻修手术、术前使用麻醉剂情况、付款人状态和糖尿病等因素。
共纳入602例患者。两组患者的所有PROs均有显著改善。BMI≥35与基线时较高的ODI相关（50.6%对47.2%，p = 0.012）以及12个月时较高的ODI相关（30.5%对25.7%，p = 0.005）。ODI变化评分无差异（21.2%对19.4%，p = 0.32）。经多变量分析，BMI≥35在12个月时并非ODI较差的预测因素（相关系数1.23，95%可信区间为-0.225至2.676）。在达到ODI最小临床重要差异的患者百分比（59.6%对64%，p = 0.46）或患者满意度（80.5%对78.9%，p = 0.63）方面，两组之间无显著差异。
体重指数≥35与较差的基线和12个月PROs相关，然而，BMI组间的变化评分无差异。在控制重要协变量后，BMI大于35并非12个月时PROs较差的独立预测因素。
