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. 2018 Jan 1;43(1):22-27.
doi: 10.1097/BRS.0000000000002456.

Do Obese and Extremely Obese Patients Lose Weight After Lumbar Spine Fusions? Analysis of a Cohort of 7303 Patients from the Kaiser National Spine Registry

Paul T Akins  1 , Maria Cs Inacio  2 , Johannas A Bernbeck  2 , Jessica Harris  2 , Yuexin X Chen  2 , Heather A Prentice  2 , Kern H Guppy  1
Affiliations

Do Obese and Extremely Obese Patients Lose Weight After Lumbar Spine Fusions? Analysis of a Cohort of 7303 Patients from the Kaiser National Spine Registry

Paul T Akins et al. Spine (Phila Pa 1976). .

Abstract

MINI: The outcome of interest was ≥ 5% weight change 1 year postoperative from baseline. Seven thousand three hundred three lumbar fusions in the Kaiser Permanente Spine Registry between 2009 and 2013 were analyzed. Weight loss occurred in: body mass index < 30, 11.1%; obese, BMI 30 to 39, 16.6%, odds ratio = 1.42; extremely obese, body mass index ≥40, 21.1%, odds ratio = 1.73.

Study design: A retrospective cohort study from the Kaiser Permanente Spine Registry.

Objective: The aim of this study was to determine whether obese and extremely obese patients with lumbar spine fusions lost a clinically significant amount of weight (≥5%) 1 year after their surgery.

Summary of background data: Obesity in the United States has a prevalence of 35% and is a global health issue. Obesity is associated with lumbar spine disease. There is limited evidence regarding postsurgical weight loss after spine surgery.

Methods: Adult patients in the Kaiser Permanente Spine Registry with lumbar fusions performed between 2009 and 2013 were included in the study sample (n = 7303). The outcome of interest was ≥5% weight change 1 year postoperative from baseline. Three body mass index (BMI) groups were analyzed (BMI < 30; 30-39 obese; ≥40 extremely obese). Covariate analysis, multivariable logistic regression, odds ratios (ORs), and 95% confidence intervals (95% CIs) are provided.

Results: At the time of spine surgery, 4456 (61%) had a BMI < 30, 2519 (34.5%) had a BMI between 30 and 39, 232 (3.2%) had a BMI ≥40, and 96 (1.3%) were missing their intraoperative BMI. We observed the following weight loss pattern: BMI < 30, 11.1%; BMI 30 to 39, 16.6%; BMI ≥40, 21.1%. We observed the following weight gain pattern: BMI < 30, 15.6%; BMI 30 to 39, 12.7%; BMI ≥40, 9.5%. After risk-adjustment, obese and extremely obese patients were more likely to lose a clinically significant amount of weight 1 year after surgery (BMI 30-39: OR = 1.42, 95% CI 1.22-1.65; BMI ≥40: OR = 1.73, 95% CI 1.21-2.47) compared with nonobese patients.

Conclusion: In this large cohort of patients with lumbar spinal fusions, we observed more significant weight loss in obese and extremely obese patients than nonobese patients. Additional research is needed to determine whether this weight loss is due to improvements in back pain and increased physical activity.

Level of evidence: 3.

Plain language summary

A retrospective cohort study from the Kaiser Permanente Spine Registry. The aim of this study was to determine whether obese and extremely obese patients with lumbar spine fusions lost a clinically significant amount of weight (≥5%) 1 year after their surgery. Obesity in the United States has a prevalence of 35% and is a global health issue. Obesity is associated with lumbar spine disease. There is limited evidence regarding postsurgical weight loss after spine surgery. Adult patients in the Kaiser Permanente Spine Registry with lumbar fusions performed between 2009 and 2013 were included in the study sample (n = 7303). The outcome of interest was ≥5% weight change 1 year postoperative from baseline. Three body mass index (BMI) groups were analyzed (BMI < 30; 30–39 obese; ≥40 extremely obese). Covariate analysis, multivariable logistic regression, odds ratios (ORs), and 95% confidence intervals (95% CIs) are provided. At the time of spine surgery, 4456 (61%) had a BMI < 30, 2519 (34.5%) had a BMI between 30 and 39, 232 (3.2%) had a BMI ≥40, and 96 (1.3%) were missing their intraoperative BMI. We observed the following weight loss pattern: BMI < 30, 11.1%; BMI 30 to 39, 16.6%; BMI ≥40, 21.1%. We observed the following weight gain pattern: BMI < 30, 15.6%; BMI 30 to 39, 12.7%; BMI ≥40, 9.5%. After risk-adjustment, obese and extremely obese patients were more likely to lose a clinically significant amount of weight 1 year after surgery (BMI 30–39: OR = 1.42, 95% CI 1.22–1.65; BMI ≥40: OR = 1.73, 95% CI 1.21–2.47) compared with nonobese patients. In this large cohort of patients with lumbar spinal fusions, we observed more significant weight loss in obese and extremely obese patients than nonobese patients. Additional research is needed to determine whether this weight loss is due to improvements in back pain and increased physical activity. Level of Evidence: 3.

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Comment in

  • TO THE EDITOR.
    Kroeger CM, Allison DB, Thomas DM, Siu CO. Kroeger CM, et al. Spine (Phila Pa 1976). 2018 Apr 15;43(8):E492-E493. doi: 10.1097/BRS.0000000000002564. Spine (Phila Pa 1976). 2018. PMID: 29595623 Free PMC article. No abstract available.
  • TO THE EDITOR.
    Akins PT, Inacio MCS, Prentice HA, Guppy KH. Akins PT, et al. Spine (Phila Pa 1976). 2018 Apr 15;43(8):E493. doi: 10.1097/BRS.0000000000002600. Spine (Phila Pa 1976). 2018. PMID: 29595624 No abstract available.

References

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