Does Obesity Affect Outcomes in the Lumbar Spine Patient?

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  • DS. Surgery for IDH is not as effective in obese patients. Nonoperative

    D. Raymond Knapp, MD , Christopher I. Shaffrey, MD

    Scoliosis Research Society Morbidity and Mortality Committee7;1University of Virginia, Charlottesville, VA, USA; 2Twin Cities

    Spine Center, Minneapolis, MN, USA; 3University of Minnesota,4

    96S Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S149Streatment may not be as effective in obese patients with IDH, SpS, or DS.

    FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

    any applicable devices or drugs.

    doi: 10.1016/j.spinee.2010.07.255Saturday, October 9, 20107:258:25 AM

    General Session: Best Papers

    207. Does Obesity Affect Outcomes in the Lumbar Spine Patient?

    Jeffrey A. Rihn, MD1, Kristen Radcliff, MD1, Alan S. Hilibrand, MD1,

    Wenyan Zhao, MS2, Emily Blood, MS2, Alexander R. Vaccaro, MD, PhD1,

    Todd J. Albert, MD1, James N. Weinstein, MS, DO2; 1Thomas Jefferson

    University Hospital, The Rothman Institute, Philadelphia, PA, USA;2The Dartmouth Institute for Health Policy and Clinical Practice,

    Lebanon, NH, USA

    BACKGROUND CONTEXT: The affect of obesity on the treatment

    outcomes for lumbar degenerative disorders remains unknown.

    PURPOSE: The purpose of this study is to determine if obesity affects

    treatment outcomes for lumbar intervertebral disc herniation (IDH), steno-

    sis (SpS) and degenerative spondylolisthesis (DS).

    STUDY DESIGN/SETTING: As-treated analysis on the combined

    randomized and observational cohorts from the Spine Patient Outcomes

    Research Trail (SPORT).

    PATIENT SAMPLE: Patients enrolled in SPORT for IDH, SpS, or DS

    treatment.

    OUTCOME MEASURES: ODI, SF-36 bodily pain (BP) and physical

    function (PF) scores and secondary outcome measures.

    METHODS: A comparison was made between patients with a body mass

    ndex (BMI) less than 30 (n5552 IDH, 373 SpS, 376 DS) and those with

    a BMI greater than or equal to 30 (n5245 IDH, 261 SpS, 225 DS). Obesity

    was defined as a BMI greater than or equal to 30. Baseline patient character-

    istics, intraoperative data, and complications were documented. Primary and

    secondary outcomes were measured at baseline and regular follow-up time

    intervals up to 4 years. The difference in improvement from operative and

    nonoperative treatment (treatment effect) was determined at each follow-

    up interval.

    RESULTS: At 4-years follow-up, operative and nonoperative treatment

    provided improvement in all primary outcome measures over baseline in

    patients with BMI of less than 30 and greater than or equal to 30. For IDH

    and SpS patients, there were no differences in the surgical complication or re-

    operation rates between groups. DS patients with BMI greater than or equal to

    30 had a higher postoperative infection rate (5% vs. 1%, p50.05) and twice

    the reoperation rate at 4-years follow-up (20% vs. 11%, p50.01) than those

    with BMI less than 30. At 4-years, operative treatment of SpS and DS was

    equally effective in both BMI groups in terms of the primary outcome mea-

    sures, with the exception that obese DS patients had worse SF36 PF scores

    compared to nonobese patients (27.1 vs. 22.6, p50.017). IDH patients with

    a BMI greater than or equal to 30 did worse with operative treatment than

    those with BMI less than 30 in all primary outcome measures. With nonoper-

    ative treatment, SpS patients with BMI greater than or equal to 30 did worse in

    regards to all three primary outcome measures, and IDH and DS patients with

    BMI greater than or equal to 30 had similar SF-36 outcomes but worse ODI

    outcomes. Treatment effects for all lumbar conditions were significant within

    each BMI group for all primary outcome measures, in favor of surgery. There

    were no significant differences in the treatment effect for any primary or sec-

    ondary outcome measures at 4 years between those with BMI less than 30 and

    greater than or equal to 30, with the exception of the treatment effects for ODI

    in the SpS patients (-7.4 vs. -13.9, p50.037) and SF-36 PF in the DS patients

    (14.0 vs. 25.6, p50.004).

    CONCLUSIONS: Obesity does not affect the clinical outcome of

    operative treatment for SpS. There are higher rates of infection and reop-

    eration and a lower SF-36 PF score in obese patients following surgery forAll referenced figures and tables will be available at the Annual MeeMinneapolis, MN, USA; University of California-San Francisco,

    San Francisco, CA, USA; 5Kenton D Leatherman Spine Center,

    Louisville, KY, USA; 6Orlando Health, Orlando, FL, USA; 7SRS,

    Milwaukee, WI, USA

    BACKGROUND CONTEXT: Currently few studies regarding complica-

    tions and mortality associated with operative treatment of pediatric spinal

    disorders are available to guide the surgeon.

    PURPOSE: This study provides more detailed complication and mortality

    data with an analysis of 23,918 pediatric cases reported in the multicenter

    multi-surgeon Scoliosis Research Society (SRS) Morbidity and Mortality

    (M&M) database.

    STUDY DESIGN/SETTING: Retrospective review of prospectively

    collected complications database.

    PATIENT SAMPLE: 23,918 operative pediatric spine cases reported

    from 20042007.

    OUTCOME MEASURES: Complications and mortality as reported in

    the perioperative period.

    METHODS: The SRS M&M database was queried for the years 2004

    2007. Inclusion criterion was age!18. Cases were categorized by opera-tion type and disease process. Multiple details on the surgical approach,

    use of neurophysiological monitoring and type of instrumentation were

    recorded. Major perioperative complications and deaths were evaluated.

    Statistical analysis was performed with chi square testing with a P- value

    of!0.05 considered significant.RESULTS: 23,918 patients were included. The mean age was 13 with

    a standard deviation of 3.6 years. Diseases reported were predominantly

    deformity including scoliosis (19642), kyphosis (1455), spondylolisthesis

    (748) and trauma (478). The overall complication rate was 8.5%. Major

    complications are listed in table 1. Complications and mortality by dis-

    ease process are listed in table 2. Complications by operation type are

    listed in table 3. The major complications were due to infection or respi-

    ratory concerns. Patients undergoing revision (2034) and osteotomy

    (2787) operations were more likely to suffer a complication and new neu-

    rological deficit. 31 deaths were reported for an overall rate of 0.13%.

    Respiratory complications were the most common etiology of mortality

    (13). 84% (26) of deaths occurred in children undergoing scoliosis

    correction.

    CONCLUSIONS: Spinal surgery in children is associated with a range of

    complications depending on type of operation, but a low mortality rate.

    Patients undergoing more aggressive corrective procedures for deformity

    are more likely to suffer complications.

    FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

    any applicable devices or drugs.

    doi: 10.1016/j.spinee.2010.07.256

    209. Postoperative Improvement in Health Related Quality of Life:

    A National Comparison of Surgical Treatment for Focal (12 Level)

    Lumbar Spinal Stenosis Compared to Total Joint Replacement for

    Osteoarthritis

    Y. Raja Rampersaud, MD, FRCSC1, Eugene Wai, MD, FRCSC2,

    Edward Abraham, MD, FRCSC3, David Alexander, MD, FRCSC4,208. Morbidity and Mortality Associated with the Operative

    Treatment of Disorders of the Pediatric Spine: A Report

    from the SRS M&M Committee

    Kai-Ming Fu, MD, PhD1, Justin Smith, MD, PhD1, David Hamilton, MD1,

    Joseph H. Perra, MD2, David W. Polly, MD3, Christopher P. Ames, MD4,

    Sigurd H. Berven, MD4, Steven D. Glassman, MD5,6 1ting and will be included with the post-meeting online content.

    Does Obesity Affect Outcomes in the Lumbar Spine Patient?Background contextPurposeStudy design/settingPatient sampleOutcome measuresMethodsResultsConclusionsFDA device/drug status

    Morbidity and Mortality Associated with the Operative Treatment of Disorders of the Pediatric Spine: A Report from the SRS ...Background contextPurposeStudy design/settingPatient sampleOutcome measuresMethodsResultsConclusionsFDA device/drug status

    Postoperative Improvement in Health Related Quality of Life: A National Comparison of Surgical Treatment for Focal (12 Lev ...

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