TY - JOUR
T1 - Assessing the impact of obesity on full endoscopic spine surgery
T2 - surgical site infections, surgery durations, early complications, and short-term functional outcomes
AU - Leyendecker, Jannik
AU - Benedict, Braeden
AU - Gumbs, Chayanne
AU - Eysel, Peer
AU - Bredow, Jan
AU - Telfeian, Albert
AU - Derman, Peter
AU - Kashlan, Osama
AU - Amin, Anubhav
AU - Konakondla, Sanjay
AU - Hofstetter, Christoph P.
AU - Ogunlade, John
N1 - Publisher Copyright:
© 2024 American Association of Neurological Surgeons. All rights reserved.
PY - 2024/3
Y1 - 2024/3
N2 - OBJECTIVE An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients. METHODS Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18–30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure. RESULTS A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (−3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (−4.4 ± 3.2 vs −2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: −11.4 ± 11.4 vs −9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: −4.3 ± 3.9 vs −3.5 ± 3.8, p = 0.28). CONCLUSIONS The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.
AB - OBJECTIVE An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients. METHODS Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18–30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure. RESULTS A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (−3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (−4.4 ± 3.2 vs −2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: −11.4 ± 11.4 vs −9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: −4.3 ± 3.9 vs −3.5 ± 3.8, p = 0.28). CONCLUSIONS The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.
KW - complications
KW - full endoscopic spine surgery
KW - infection
KW - lumbar
KW - obesity
UR - http://www.scopus.com/inward/record.url?scp=85186712843&partnerID=8YFLogxK
U2 - 10.3171/2023.10.SPINE23936
DO - 10.3171/2023.10.SPINE23936
M3 - Article
C2 - 38064701
AN - SCOPUS:85186712843
SN - 1547-5654
VL - 40
SP - 359
EP - 364
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 3
ER -