Influence of dynamic preoperative body mass index changes on patient-reported outcomes after surgery for degenerative lu
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ORIGINAL ARTICLE
Influence of dynamic preoperative body mass index changes on patient-reported outcomes after surgery for degenerative lumbar spine disease Alessandro Siccoli 1,2 & Marc L. Schröder 1 & Victor E. Staartjes 1,3,4 Received: 28 August 2020 / Revised: 3 November 2020 / Accepted: 2 December 2020 # The Author(s) 2020
Abstract Psychological factors demonstrably and often massively influence outcomes of degenerative spine surgery, and one could hypothesize that preoperative weight loss may correlate with motivation and lifestyle adjustment, thus leading to potentially enhanced outcomes. We aimed to evaluate the effect of preoperative weight loss or gain, respectively, on patient-reported outcomes after lumbar spine surgery. Weight loss was defined as a BMI decrease of ≤ − 0.5 kg/m2 over a period of at least 1 month, and weight gain as a BMI increase of ≥ 0.5 kg/m2 in the same time period, respectively. The primary endpoint was set as the achievement of the minimum clinically important difference (MCID) in the ODI at 1 or 2 years postoperatively. A total of 154 patients were included. Weight loss (odds ratio (OR): 1.18, 95% confidence interval (CI): 0.52 to 2.80) and weight gain (OR: 1.03, 95% CI: 0.43 to 2.55) showed no significant influence on MCID achievement for ODI compared to a stable BMI. The same results were observed when analysing longterm NRS-BP and NRS-LP. Regression analysis showed no correlation between BMI change and PROM change scores for any of the three PROMs. Adjustment for age and gender did not alter results. Our findings suggest that both preoperative weight loss and weight gain may have no measurable effect on long-term postoperative outcome compared to a stable BMI. Weight loss preoperatively—as a potential surrogate sign of patient motivation and lifestyle change—may thus not influence postoperative outcomes. Keywords Obesity . Overweight . Weight loss . Weight gain . Outcome
Introduction Obesity is well known to be an independent risk factor for several comorbidities such as cardiovascular diseases or hypertension [24, 34]. Additionally, current literature suggests that obesity actively contributes to low back pain [11, 21, 42, 54], due to the effect of excessive weight on the lumbar spine, This research has never previously been submitted for review or presented at any conferences * Victor E. Staartjes [email protected] 1
Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
2
Faculty of Medicine, University of Zurich, Zurich, Switzerland
3
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
4
Bergman Clinics, Naarden, Rijksweg 69, 1411, GE Naarden, The Netherlands
and thus consequently leads to a higher probability for that particular patient subpopulation to undergo lumbar spinal surgery [32]. The National Surgery Quality Improvement Program (NSQIP) database already stated that 44% of patients in a lumbar spine surgery cohort between 2005 and 2010 were obese [8], with
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