Impact of Body Mass Index on PROMIS Outcomes Following Lumbar Decompression

Overview

Journal Acta Neurochir (Wien)

Specialty Neurosurgery

Date 2023 Mar 9

PMID 36892729

Authors

James W Nie

Timothy J Hartman

Eileen Zheng

Omolabake O Oyetayo

Keith R MacGregor

Vincent P Federico

Dustin H Massel

Arash J Sayari

Kern Singh

Affiliations

Soon will be listed here.

Abstract

Background: No studies have examined the impact of body mass index (BMI) on newer Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes in patients undergoing lumbar decompression (LD).

Methods: Patients undergoing LD with preoperative PROMIS measures were stratified into four cohorts: normal (18.5 ≤ BMI < 25 kg/m), overweight (25 ≤ BMI < 30 kg/m), obese I (30 ≤ BMI < 35 kg/m), and obese II-III (BMI ≥ 35 kg/m). Demographics, perioperative characteristics, and patient-reported outcomes (PROs) were obtained. PROs of PROMIS Physical Function (PROMIS-PF), PROMIS Anxiety (PROMIS-A), PROMIS Pain Interference (PROMIS-PI), PROMIS Sleep Disturbance (PROMIS-SD), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) Back Pain (VAS-BP), VAS Leg Pain (VAS-LP), and Oswestry Disability Index (ODI) were collected at preoperative and up to 2-year postoperative time points. Minimum clinically important difference (MCID) achievement was determined through comparison of previously established values. Comparison between cohorts were determined through inferential statistics.

Results: A total of 473 patients were identified, with stratification of 125 patients in the normal cohort, 161 in the overweight cohort, 101 in the obese I cohort, and 87 in the obese II-III cohort. Mean postoperative follow-up time was 13.51 ± 8.72 months. Higher BMI patients had higher operative times, longer postoperative length of stay, and greater narcotic consumption (p ≤ 0.001, all). Patients with higher BMI (obese I, obese II-III) reported inferior preoperative PROMIS-PF, VAS-BP, and ODI scores (p ≤ 0.003, all). Postoperatively, obese I-III cohorts demonstrated inferior PROMIS-PF, PHQ-9, VAS-BP, and ODI scores at final follow-up (p ≤ 0.016, all). However, patients demonstrated similar postoperative changes and MCID achievement regardless of preoperative BMI.

Conclusion: Patients undergoing lumbar decompression demonstrated similar postoperative improvement in physical function, anxiety, pain interference, sleep disturbance, mental health, pain, and disability outcomes independent of preoperative BMI. However, obese patients reported worse physical function, mental health, back pain, and disability outcomes at final postoperative follow-up. Patients with greater BMI undergoing lumbar decompression demonstrate inferior postoperative clinical outcomes.

Citing Articles

Disability and pain after lumbar surgery-group-based trajectory analysis.

Koivunen K, Arokoski J, Widbom-Kolhanen S, Pernaa K, Juhola J, Saltychev M PLoS One. 2025; 20(1):e0313528.

PMID: 39787104 PMC: 11717237. DOI: 10.1371/journal.pone.0313528.

Letter: "Impact of body mass index on PROMIS outcomes following lumbar decompression".

Ozden F Acta Neurochir (Wien). 2023; 165(12):3959-3960.

PMID: 37721565 DOI: 10.1007/s00701-023-05804-2.

References

Amtmann D, Cook K, Jensen M, Chen W, Choi S, Revicki D . Development of a PROMIS item bank to measure pain interference. Pain. 2010; 150(1):173-182. PMC: 2916053. DOI: 10.1016/j.pain.2010.04.025. View

Belcaid I, Eipe N . Perioperative Pain Management in Morbid Obesity. Drugs. 2019; 79(11):1163-1175. DOI: 10.1007/s40265-019-01156-3. View

Chen C, Kroenke K, Stump T, Kean J, Carpenter J, Krebs E . Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials. Pain. 2017; 159(4):775-782. PMC: 5860950. DOI: 10.1097/j.pain.0000000000001121. View

Chiolero A, Faeh D, Paccaud F, Cornuz J . Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr. 2008; 87(4):801-9. DOI: 10.1093/ajcn/87.4.801. View

Chou L, Brady S, Urquhart D, Teichtahl A, Cicuttini F, Pasco J . The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders: A Population-Based, Cross-Sectional Study of Men. Medicine (Baltimore). 2016; 95(15):e3367. PMC: 4839843. DOI: 10.1097/MD.0000000000003367. View

de la Garza-Ramos R, Bydon M, Abt N, Sciubba D, Wolinsky J, Bydon A . The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine (Phila Pa 1976). 2014; 40(1):56-61. DOI: 10.1097/BRS.0000000000000655. View

Dority J, Hassan Z, Chau D . Anesthetic implications of obesity in the surgical patient. Clin Colon Rectal Surg. 2012; 24(4):222-8. PMC: 3311489. DOI: 10.1055/s-0031-1295685. View

Epstein N . More risks and complications for elective spine surgery in morbidly obese patients. Surg Neurol Int. 2017; 8:66. PMC: 5421202. DOI: 10.4103/sni.sni_49_17. View

Goyal A, Elminawy M, Kerezoudis P, Lu V, Yolcu Y, Alvi M . Impact of obesity on outcomes following lumbar spine surgery: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2018; 177:27-36. DOI: 10.1016/j.clineuro.2018.12.012. View

10.

Haws B, Khechen B, Bawa M, Patel D, Bawa H, Bohl D . The Patient-Reported Outcomes Measurement Information System in spine surgery: a systematic review. J Neurosurg Spine. 2019; 30(3):405-413. DOI: 10.3171/2018.8.SPINE18608. View

11.

Jiang J, Teng Y, Fan Z, Khan S, Xia Y . Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res. 2013; 472(3):968-75. PMC: 3916601. DOI: 10.1007/s11999-013-3346-3. View

12.

Lynch C, Cha E, Jenkins N, Parrish J, Mohan S, Jadczak C . The Minimum Clinically Important Difference for Patient Health Questionnaire-9 in Minimally Invasive Transforaminal Interbody Fusion. Spine (Phila Pa 1976). 2020; 46(9):603-609. DOI: 10.1097/BRS.0000000000003853. View

13.

Ogden C, Fryar C, Hales C, Carroll M, Aoki Y, Freedman D . Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016. JAMA. 2018; 319(23):2410-2418. PMC: 6393914. DOI: 10.1001/jama.2018.5158. View

14.

Pantalone K, Hobbs T, Chagin K, Kong S, Wells B, Kattan M . Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system. BMJ Open. 2017; 7(11):e017583. PMC: 5702021. DOI: 10.1136/bmjopen-2017-017583. View

15.

Parker S, Adogwa O, Paul A, Anderson W, Aaronson O, Cheng J . Utility of minimum clinically important difference in assessing pain, disability, and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis. J Neurosurg Spine. 2011; 14(5):598-604. DOI: 10.3171/2010.12.SPINE10472. View

16.

Patel N, Bagan B, Vadera S, Maltenfort M, Deutsch H, Vaccaro A . Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine. 2007; 6(4):291-7. DOI: 10.3171/spi.2007.6.4.1. View

17.

Pi-Sunyer F . Comorbidities of overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 1999; 31(11 Suppl):S602-8. DOI: 10.1097/00005768-199911001-00019. View

18.

Rihn J, Radcliff K, Hilibrand A, Anderson D, Zhao W, Lurie J . Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2012; 37(23):1933-46. PMC: 3757558. DOI: 10.1097/BRS.0b013e31825e21b2. View

19.

Shiri R, Lallukka T, Karppinen J, Viikari-Juntura E . Obesity as a risk factor for sciatica: a meta-analysis. Am J Epidemiol. 2014; 179(8):929-37. DOI: 10.1093/aje/kwu007. View

20.

Soroceanu A, Burton D, Diebo B, Smith J, Hostin R, Shaffrey C . Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery. J Neurosurg Spine. 2015; 23(5):656-664. DOI: 10.3171/2015.3.SPINE14743. View