Mulvaney Graham, Rice Olivia M, Rossi Vincent, Peters David, Smith Mark, Patt Joshua, Pfortmiller Deborah, Asher Anthony L, Kim Paul, Bernard Joe, McGirt Matthew
Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.
Neurosurgery. 2021 Jan 13;88(2):285-294. doi: 10.1093/neuros/nyaa414.
Elevated body mass index (BMI) is a well-known risk factor for surgical complications in lumbar surgery. However, its effect on surgical effectiveness independent of surgical complications is unclear.
To determine increasing BMI's effect on functional outcomes following lumbar fusion surgery, independent of surgical complications.
We retrospectively analyzed a prospectively built, patient-reported, quality of life registry representing 75 hospital systems. We evaluated 1- to 3-level elective lumbar fusions. Patients who experienced surgical complications were excluded. A stepwise multivariate regression model assessed factors independently associated with 1-yr Oswestry Disability Index (ODI), preop to 1-yr ODI change, and achievement of minimal clinically important difference (MCID).
A total of 8171 patients met inclusion criteria: 2435 with class I obesity (BMI 30-35 kg/m2), 1328 with class II (35-40 kg/m2), and 760 with class III (≥40 kg/m2). Increasing BMI was independently associated with worse 12-mo ODI (t = 8.005, P < .001) and decreased likelihood of achieving MCID (odds ratio [OR] = 0.977, P < .001). One year after surgery, mean ODI, ODI change, and percentage achieving MCID worsened with class I, class II, and class III vs nonobese cohorts (P < .001) in stepwise fashion.
Increasing BMI is associated with decreased effectiveness of 1- to 3-level elective lumbar fusion, despite absence of surgical complications. BMI ≥ 30 kg/m2 is, therefore, a risk factor for both surgical complication and reduced benefit from lumbar fusion.
体重指数（BMI）升高是腰椎手术中手术并发症的一个众所周知的危险因素。然而，其对独立于手术并发症的手术效果的影响尚不清楚。
确定BMI升高对腰椎融合手术后功能结局的影响，独立于手术并发症。
我们回顾性分析了一个前瞻性建立的、患者报告的、代表75个医院系统的生活质量登记库。我们评估了1至3节段的择期腰椎融合术。经历手术并发症的患者被排除。一个逐步多元回归模型评估了与1年Oswestry功能障碍指数（ODI）、术前至1年ODI变化以及达到最小临床重要差异（MCID）独立相关的因素。
共有8171例患者符合纳入标准：2435例I类肥胖（BMI 30 - 35kg/m²），1328例II类（35 - 40kg/m²），760例III类（≥40kg/m²）。BMI升高与更差的12个月ODI独立相关（t = 8.005，P <.001），且达到MCID的可能性降低（优势比[OR] = 0.977，P <.001）。术后1年，I类、II类和III类患者与非肥胖队列相比，平均ODI、ODI变化以及达到MCID的百分比逐步恶化（P <.001）。
尽管没有手术并发症，但BMI升高与1至3节段择期腰椎融合术的效果降低相关。因此，BMI≥30kg/m²是手术并发症和腰椎融合术获益减少的危险因素。
