Owens R Kirk, Djurasovic Mladen, Onyekwelu Ikemefuna, Bratcher Kelly R, McGraw Katlyn E, Carreon Leah Y
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.
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;16(10):1178-1183. doi: 10.1016/j.spinee.2016.06.005. Epub 2016 Jun 9.
Obesity is a growing problem in health care. Studies have demonstrated similar functional outcomes but higher complication rates after spine surgery in obese patients.
This study aimed to compare patient-reported outcomes and revision rates 5 years after instrumented posterior lumbar fusion between normal, overweight, and obese patients.
Propensity matched case control.
Patients 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.
Oswestry 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).
Three comparison groups, one with body mass index (BMI) ≥20-25 kg/m (normal), another with ≥25-<30 kg/m (overweight), and another with ≥30-40 kg/m (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.
There 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.
When 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.
肥胖在医疗保健领域是一个日益严重的问题。研究表明，肥胖患者脊柱手术后的功能结局相似，但并发症发生率更高。
本研究旨在比较正常、超重和肥胖患者在进行后路腰椎融合内固定术后5年的患者报告结局和翻修率。
倾向评分匹配病例对照研究。
确定了2001年至2008年在单一脊柱专科中心接受后路腰椎融合内固定术且术前和术后5年结局测量完整的患者。
奥斯威斯残疾指数（ODI）、背痛（0 - 10）和腿痛（0 - 10）数字评分量表，以及简明健康调查36项身体综合总结评分（SF - 36 PCS）。
使用倾向评分匹配技术，根据人口统计学、基线临床结局测量和手术特征创建了三个比较组，一组体重指数（BMI）≥20 - 25kg/m²（正常），另一组≥25 - ＜30kg/m²（超重），另一组≥30 - 40kg/m²（肥胖）。比较三组术后5年的结局测量和翻修率。采用单因素方差分析比较连续变量，采用Fisher精确检验比较组间分类变量。显著性设定为p ＜.01。
每个队列匹配了82例病例。超重和肥胖患者的估计失血量（440cc对702cc对798cc，p =.000）和手术时间（234分钟对263分钟对275分钟，p =.003）显著更长。三组间ODI改善情况（14.2对9.6对10.4，p =.226）、SF - 36 PCS（5.9对2.9对3.5，p =.361）、背痛（3.0对2.0对2.1，p =.028）和腿痛（3.0对2.3对2.3，p =.311）评分相似。三组的翻修率（14对15对13，p =.917）以及初次手术与翻修手术之间的时间（p =.990）也相似。
在考虑部分患者报告结局和5年后的翻修手术时，基线BMI＞25的患者在接受后路腰椎融合手术时，其结局似乎并不比BMI为20 - 25的正常患者差。对于有适当手术指征的患者，肥胖不应被视为手术禁忌证。
