Does Obesity Affect Outcomes in the Lumbar Spine Patient?

  • Published on
    29-Nov-2016

  • View
    214

  • Download
    2

Embed Size (px)

Transcript

<ul><li><p>DS. Surgery for IDH is not as effective in obese patients. Nonoperative</p><p>D. Raymond Knapp, MD , Christopher I. Shaffrey, MD</p><p>Scoliosis Research Society Morbidity and Mortality Committee7;1University of Virginia, Charlottesville, VA, USA; 2Twin Cities</p><p>Spine Center, Minneapolis, MN, USA; 3University of Minnesota,4</p><p>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.</p><p>FDA DEVICE/DRUG STATUS: This abstract does not discuss or include</p><p>any applicable devices or drugs.</p><p>doi: 10.1016/j.spinee.2010.07.255Saturday, October 9, 20107:258:25 AM</p><p>General Session: Best Papers</p><p>207. Does Obesity Affect Outcomes in the Lumbar Spine Patient?</p><p>Jeffrey A. Rihn, MD1, Kristen Radcliff, MD1, Alan S. Hilibrand, MD1,</p><p>Wenyan Zhao, MS2, Emily Blood, MS2, Alexander R. Vaccaro, MD, PhD1,</p><p>Todd J. Albert, MD1, James N. Weinstein, MS, DO2; 1Thomas Jefferson</p><p>University Hospital, The Rothman Institute, Philadelphia, PA, USA;2The Dartmouth Institute for Health Policy and Clinical Practice,</p><p>Lebanon, NH, USA</p><p>BACKGROUND CONTEXT: The affect of obesity on the treatment</p><p>outcomes for lumbar degenerative disorders remains unknown.</p><p>PURPOSE: The purpose of this study is to determine if obesity affects</p><p>treatment outcomes for lumbar intervertebral disc herniation (IDH), steno-</p><p>sis (SpS) and degenerative spondylolisthesis (DS).</p><p>STUDY DESIGN/SETTING: As-treated analysis on the combined</p><p>randomized and observational cohorts from the Spine Patient Outcomes</p><p>Research Trail (SPORT).</p><p>PATIENT SAMPLE: Patients enrolled in SPORT for IDH, SpS, or DS</p><p>treatment.</p><p>OUTCOME MEASURES: ODI, SF-36 bodily pain (BP) and physical</p><p>function (PF) scores and secondary outcome measures.</p><p>METHODS: A comparison was made between patients with a body mass</p><p>ndex (BMI) less than 30 (n5552 IDH, 373 SpS, 376 DS) and those with</p><p>a BMI greater than or equal to 30 (n5245 IDH, 261 SpS, 225 DS). Obesity</p><p>was defined as a BMI greater than or equal to 30. Baseline patient character-</p><p>istics, intraoperative data, and complications were documented. Primary and</p><p>secondary outcomes were measured at baseline and regular follow-up time</p><p>intervals up to 4 years. The difference in improvement from operative and</p><p>nonoperative treatment (treatment effect) was determined at each follow-</p><p>up interval.</p><p>RESULTS: At 4-years follow-up, operative and nonoperative treatment</p><p>provided improvement in all primary outcome measures over baseline in</p><p>patients with BMI of less than 30 and greater than or equal to 30. For IDH</p><p>and SpS patients, there were no differences in the surgical complication or re-</p><p>operation rates between groups. DS patients with BMI greater than or equal to</p><p>30 had a higher postoperative infection rate (5% vs. 1%, p50.05) and twice</p><p>the reoperation rate at 4-years follow-up (20% vs. 11%, p50.01) than those</p><p>with BMI less than 30. At 4-years, operative treatment of SpS and DS was</p><p>equally effective in both BMI groups in terms of the primary outcome mea-</p><p>sures, with the exception that obese DS patients had worse SF36 PF scores</p><p>compared to nonobese patients (27.1 vs. 22.6, p50.017). IDH patients with</p><p>a BMI greater than or equal to 30 did worse with operative treatment than</p><p>those with BMI less than 30 in all primary outcome measures. With nonoper-</p><p>ative treatment, SpS patients with BMI greater than or equal to 30 did worse in</p><p>regards to all three primary outcome measures, and IDH and DS patients with</p><p>BMI greater than or equal to 30 had similar SF-36 outcomes but worse ODI</p><p>outcomes. Treatment effects for all lumbar conditions were significant within</p><p>each BMI group for all primary outcome measures, in favor of surgery. There</p><p>were no significant differences in the treatment effect for any primary or sec-</p><p>ondary outcome measures at 4 years between those with BMI less than 30 and</p><p>greater than or equal to 30, with the exception of the treatment effects for ODI</p><p>in the SpS patients (-7.4 vs. -13.9, p50.037) and SF-36 PF in the DS patients</p><p>(14.0 vs. 25.6, p50.004).</p><p>CONCLUSIONS: Obesity does not affect the clinical outcome of</p><p>operative treatment for SpS. There are higher rates of infection and reop-</p><p>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,</p><p>San Francisco, CA, USA; 5Kenton D Leatherman Spine Center,</p><p>Louisville, KY, USA; 6Orlando Health, Orlando, FL, USA; 7SRS,</p><p>Milwaukee, WI, USA</p><p>BACKGROUND CONTEXT: Currently few studies regarding complica-</p><p>tions and mortality associated with operative treatment of pediatric spinal</p><p>disorders are available to guide the surgeon.</p><p>PURPOSE: This study provides more detailed complication and mortality</p><p>data with an analysis of 23,918 pediatric cases reported in the multicenter</p><p>multi-surgeon Scoliosis Research Society (SRS) Morbidity and Mortality</p><p>(M&amp;M) database.</p><p>STUDY DESIGN/SETTING: Retrospective review of prospectively</p><p>collected complications database.</p><p>PATIENT SAMPLE: 23,918 operative pediatric spine cases reported</p><p>from 20042007.</p><p>OUTCOME MEASURES: Complications and mortality as reported in</p><p>the perioperative period.</p><p>METHODS: The SRS M&amp;M database was queried for the years 2004</p><p>2007. Inclusion criterion was age!18. Cases were categorized by opera-tion type and disease process. Multiple details on the surgical approach,</p><p>use of neurophysiological monitoring and type of instrumentation were</p><p>recorded. Major perioperative complications and deaths were evaluated.</p><p>Statistical analysis was performed with chi square testing with a P- value</p><p>of!0.05 considered significant.RESULTS: 23,918 patients were included. The mean age was 13 with</p><p>a standard deviation of 3.6 years. Diseases reported were predominantly</p><p>deformity including scoliosis (19642), kyphosis (1455), spondylolisthesis</p><p>(748) and trauma (478). The overall complication rate was 8.5%. Major</p><p>complications are listed in table 1. Complications and mortality by dis-</p><p>ease process are listed in table 2. Complications by operation type are</p><p>listed in table 3. The major complications were due to infection or respi-</p><p>ratory concerns. Patients undergoing revision (2034) and osteotomy</p><p>(2787) operations were more likely to suffer a complication and new neu-</p><p>rological deficit. 31 deaths were reported for an overall rate of 0.13%.</p><p>Respiratory complications were the most common etiology of mortality</p><p>(13). 84% (26) of deaths occurred in children undergoing scoliosis</p><p>correction.</p><p>CONCLUSIONS: Spinal surgery in children is associated with a range of</p><p>complications depending on type of operation, but a low mortality rate.</p><p>Patients undergoing more aggressive corrective procedures for deformity</p><p>are more likely to suffer complications.</p><p>FDA DEVICE/DRUG STATUS: This abstract does not discuss or include</p><p>any applicable devices or drugs.</p><p>doi: 10.1016/j.spinee.2010.07.256</p><p>209. Postoperative Improvement in Health Related Quality of Life:</p><p>A National Comparison of Surgical Treatment for Focal (12 Level)</p><p>Lumbar Spinal Stenosis Compared to Total Joint Replacement for</p><p>Osteoarthritis</p><p>Y. Raja Rampersaud, MD, FRCSC1, Eugene Wai, MD, FRCSC2,</p><p>Edward Abraham, MD, FRCSC3, David Alexander, MD, FRCSC4,208. Morbidity and Mortality Associated with the Operative</p><p>Treatment of Disorders of the Pediatric Spine: A Report</p><p>from the SRS M&amp;M Committee</p><p>Kai-Ming Fu, MD, PhD1, Justin Smith, MD, PhD1, David Hamilton, MD1,</p><p>Joseph H. Perra, MD2, David W. Polly, MD3, Christopher P. Ames, MD4,</p><p>Sigurd H. Berven, MD4, Steven D. Glassman, MD5,6 1ting and will be included with the post-meeting online content.</p><p>Does Obesity Affect Outcomes in the Lumbar Spine Patient?Background contextPurposeStudy design/settingPatient sampleOutcome measuresMethodsResultsConclusionsFDA device/drug status</p><p>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</p><p>Postoperative Improvement in Health Related Quality of Life: A National Comparison of Surgical Treatment for Focal (12 Lev ...</p></li></ul>