Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2022 Aug;164:e341-e348. doi: 10.1016/j.wneu.2022.04.102. Epub 2022 Apr 29.
To investigate the influence of body mass index (BMI) on perioperative outcomes, postoperative patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement among workers' compensation (WC) claimants undergoing minimally invasive lumbar decompression (MIS-LD).
WC patients diagnosed with herniated nucleus pulposus undergoing single-level MIS-LD were identified. Patients were divided into 3 groups: Non-obese (<30 kg/m), Obese I (≥30 and <35 kg/m), and Obese II/III (≥35 kg/m). PROMs were collected preoperatively and at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years postoperatively. The predictive influence of BMI grouping on mean PROM scores was computed using simple linear regression. To compare PROMs between groups, post hoc pairwise comparisons of adjusted means were utilized. MCID achievement was compared between groups with χ analysis.
A total of 81 patients were in the Non-obese cohort, and 43 and 45 in the Obese I and Obese II/III cohorts, respectively. Visual analog scale (VAS) leg, Oswestry Disability Index (ODI), and 12-Item Short Form Physical Composite Score (SF-12 PCS) were worse in the Obese I cohort at 12 weeks, and SF-12 PCS was lower in the Obese I vs. Obese II/III subgroup analysis (P ≤ 0.045, all). MCID achievement rates for ODI were higher for the Non-obese group at 12 weeks and overall (P ≤ 0.049, both). MCID attainment for VAS back was higher among the Non-obese cohort at 6-weeks (P = 0.022).
Patients with higher levels of obesity were more likely to experience longer length of stay and delayed discharge following MIS-LD. Increasing BMI was generally not a significant predictor of postoperative pain, disability, or physical health PROMs at most timepoints. MCID achievement rates for disability relief were significantly higher for non-obese patients.
研究体重指数（BMI）对行微创腰椎减压术（MIS-LD）的工人赔偿（WC）索赔患者围手术期结局、术后患者报告的结局测量（PROMs）以及最小临床重要差异（MCID）实现的影响。
确定了诊断为椎间盘突出症并接受单节段 MIS-LD 的 WC 患者。患者分为 3 组：非肥胖组（<30kg/m）、肥胖 I 组（≥30 且<35kg/m）和肥胖 II/III 组（≥35kg/m）。在术前以及术后 6 周、12 周、6 个月、1 年和 2 年收集 PROMs。使用简单线性回归计算 BMI 分组对平均 PROM 评分的预测影响。为了比较组间的 PROMs，使用调整后均值的事后两两比较进行比较。使用卡方分析比较 MCID 实现情况。
共有 81 例患者纳入非肥胖组，43 例和 45 例分别纳入肥胖 I 组和肥胖 II/III 组。肥胖 I 组在术后 12 周时视觉模拟量表（VAS）腿部、Oswestry 残疾指数（ODI）和 12 项简明健康状况量表躯体成分评分（SF-12 PCS）更差，肥胖 I 组与肥胖 II/III 亚组分析相比 SF-12 PCS 更低（P≤0.045，均）。非肥胖组在术后 12 周和总体上 ODI 的 MCID 实现率更高（P≤0.049，均）。非肥胖组在术后 6 周时 VAS 背部的 MCID 获得率更高（P=0.022）。
BMI 较高的患者在接受 MIS-LD 后更有可能出现较长的住院时间和延迟出院。在大多数时间点，BMI 的增加通常不是术后疼痛、残疾或身体健康 PROMs 的显著预测因素。非肥胖患者的残疾缓解 MCID 实现率显著更高。
