O'Toole John E, Sasso Rick C, Harrop James S, Mariscal Gonzalo, Chaput Christopher D, Arnold Paul M, Witiw Christopher D, Jacobs W Bradley, Steinmetz Michael P
Rush University Medical Center, Chicago, IL.
Department Orthopaedic Surgery, Indiana University School of Medicine, Indiana Spine Group, Carmel, IN.
Spine (Phila Pa 1976). 2025 Sep 1;50(17):1208-1218. doi: 10.1097/BRS.0000000000005395. Epub 2025 May 28.
Systematic review and meta-analysis.
The objective of this study is to determine the impact of obesity on three key lumbar spinal surgery outcomes: the incidence of spinal nonunion, patient-reported outcome measures (PROMs), and the associated health care costs.
Obesity is a well-recognized risk factor in various medical fields, notably impacting outcomes in orthopedics and traumatology. While there is substantial documentation of the complications associated with obesity in general surgical procedures, the relationship between obesity and spinal surgery outcomes remains less clear. The inconsistency in the evidence presents a significant gap in our understanding of how obesity influences the results of spinal surgeries, particularly in terms of nonunion rates, patient-reported outcomes, and the associated health care costs.
A systematic search was conducted in PubMed, EMBASE, Scopus, and the Cochrane Library following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing patients with or without obesity with lumbar spinal fusion were included. Comparative studies (cohort and case-control) were included. For dichotomous variables such as spinal nonunion, analysis was conducted using odds ratios (OR); for continuous variables such as PROMs [Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and 12/36-Item Short Form Survey (SF-12/36), and costs, analyses were performed using mean differences (MD) or standardized mean differences (SMD)].
Fifteen studies with a pool of 61341 patients were included. Obesity (BMI≥30) was significantly associated with a higher nonunion frequency (OR 2.10, 95% CI: 1.23-3.60, P <0.01). The ODI was significantly worse in the obesity group (MD 6.29, 95% CI: 4.71-7.88, P <0.001). Greater pain was measured by the VAS back pain (MD 0.95, 95% CI: 0.17-1.73, P <0.05) and VAS leg pain (MD 0.94, 95% CI: 0.68-1.20, P <0.001) scales for lumbar surgery patients with obesity. The SF-12/36 showed significantly worse outcomes in patients with obesity (SMD -0.46, 95% CI: -0.82 to -0.09, P =0.01). Hospitalization costs were significantly higher in patients with obesity (SMD 0.09, 95% CI: 0.05-0.12, P <0.001).
This meta-analysis suggests that obesity is significantly associated with higher nonunion rates, poorer patient-reported outcome measures, including Oswestry Disability Index, Visual Analogue Scale, and 36-Item Short Form Survey, and higher hospitalization costs following lumbar spinal fusion.
Level III.
系统评价与荟萃分析。
本研究的目的是确定肥胖对腰椎手术三个关键结局的影响：脊柱不愈合的发生率、患者报告的结局指标（PROMs）以及相关的医疗保健成本。
肥胖是各个医学领域公认的风险因素，尤其影响骨科和创伤学的治疗结果。虽然在普通外科手术中与肥胖相关的并发症有大量文献记载，但肥胖与脊柱手术结局之间的关系仍不太明确。证据的不一致性表明，我们在理解肥胖如何影响脊柱手术结果方面存在重大差距，特别是在不愈合率、患者报告的结局以及相关的医疗保健成本方面。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，在PubMed、EMBASE、Scopus和Cochrane图书馆进行了系统检索。纳入比较有或无肥胖的患者进行腰椎融合手术的研究。纳入比较研究（队列研究和病例对照研究）。对于脊柱不愈合等二分变量，使用比值比（OR）进行分析；对于PROMs [Oswestry功能障碍指数（ODI）、视觉模拟量表（VAS）和12/36项简短健康调查（SF - 12/36）]以及成本等连续变量，使用均值差（MD）或标准化均值差（SMD）进行分析。
纳入了15项研究，共61341例患者。肥胖（BMI≥30）与更高的不愈合频率显著相关（OR 2.10，95%CI：1.23 - 3.60，P <0.01）。肥胖组的ODI明显更差（MD 6.29，95%CI：4.71 - 7.88，P <0.001）。肥胖的腰椎手术患者在VAS背痛（MD 0.95，95%CI：0.17 - 1.73，P <0.05）和VAS腿痛（MD 0.94，95%CI：0.68 - 1.20，P <0.001）量表上疼痛更严重。SF - 12/36显示肥胖患者的结局明显更差（SMD -0.46，95%CI：-0.82至-0.09，P =0.01）。肥胖患者的住院费用显著更高（SMD 0.09，95%CI：0.05 - 0.12，P <小于0.001）。
这项荟萃分析表明肥胖与更高的不愈合率、更差的患者报告结局指标（包括Oswestry功能障碍指数、视觉模拟量表和36项简短健康调查）以及腰椎融合术后更高的住院费用显著相关。
三级。
