Adindu Ebubechi, Singh Devender, Geck Matthew, Stokes John
The University of Texas Dell Medical School, Department of Surgery and Perioperative Care, Austin, TX, USA.
Ascension Texas Spine and Scoliosis, Austin TX, USA.
Spine J. 2025 Jun;25(6):1081-1095. doi: 10.1016/j.spinee.2024.12.006. Epub 2024 Dec 11.
Obesity is increasingly prevalent globally and is associated with various health issues, including spine-related disorders. Previous studies have shown mixed results regarding the impact of obesity on spine surgery outcomes.
This meta-analysis aims to evaluate the effects of obesity on perioperative and postoperative outcomes in spine surgery patients.
STUDY DESIGN/SETTING: We performed a systematic review and meta-analysis of prospective and retrospective studies comparing outcomes between obese and nonobese spine surgery patients.
The meta-analysis included 35,639 patients, of which 9,369 were obese (BMI≥30 kg/m²) and 26,270 were nonobese (BMI<30 kg/m²).
Primary outcomes included patient-reported outcome measures (PROMs) such as the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for leg and back pain. Secondary outcomes involved perioperative measures like estimated blood loss (EBL), operative time, and length of stay (LOS), as well as complication and reoperation rates.
Following PRISMA guidelines, four databases were searched for relevant studies. The quality of included studies was assessed using the Cochrane Risk of Bias tool. Mean differences were used to quantify the differences in PROMs and perioperative outcomes. Odds ratios were used to analyze differences in complication rates.
Obese patients had similar PROMs compared to nonobese patients, with differences not exceeding the minimal clinically important difference (MCID). However, obese patients experienced longer operative times, greater EBL, and extended hospital stays. They also had higher rates of postoperative complications such as Dural tears, infections, and reoperations.
While obesity is associated with certain perioperative challenges, the postoperative recovery in terms of pain and disability appears comparable between obese and nonobese patients. Spine surgeons should be aware of the increased perioperative risks but can reassure obese patients of similar long-term outcomes postsurgery.
肥胖在全球范围内日益普遍，且与各种健康问题相关，包括脊柱相关疾病。先前的研究在肥胖对脊柱手术结果的影响方面呈现出混合的结果。
本荟萃分析旨在评估肥胖对脊柱手术患者围手术期和术后结果的影响。
研究设计/地点：我们对比较肥胖和非肥胖脊柱手术患者结果的前瞻性和回顾性研究进行了系统评价和荟萃分析。
荟萃分析纳入了35639名患者，其中9369名肥胖（BMI≥30kg/m²），26270名非肥胖（BMI<30kg/m²）。
主要结果包括患者报告的结果指标（PROMs），如奥斯威斯利残疾指数（ODI）以及腿部和背部疼痛的视觉模拟量表（VAS）。次要结果涉及围手术期指标，如估计失血量（EBL）、手术时间和住院时间（LOS），以及并发症和再次手术率。
按照PRISMA指南，检索了四个数据库以查找相关研究。使用Cochrane偏倚风险工具评估纳入研究的质量。均值差异用于量化PROMs和围手术期结果的差异。比值比用于分析并发症发生率的差异。
与非肥胖患者相比，肥胖患者的PROMs相似，差异未超过最小临床重要差异（MCID）。然而，肥胖患者的手术时间更长、EBL更大且住院时间延长。他们术后出现硬膜撕裂、感染和再次手术等并发症的发生率也更高。
虽然肥胖与某些围手术期挑战相关，但肥胖和非肥胖患者在疼痛和残疾方面的术后恢复情况似乎相当。脊柱外科医生应意识到围手术期风险增加，但可以让肥胖患者放心，术后长期结果相似。
