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Obese patients report modest weight loss after surgery for lumbar spinal stenosis: a study from the Swedish spine register
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
2014 (engelsk)Inngår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 39, nr 20, s. 1725-1730Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

STUDY DESIGN:

SWESPINE, the Swedish Spine Register, was used for this cohort study.

OBJECTIVE:

Our primary aim was to determine weight change in obese patients after surgery for lumbar spinal stenosis (LSS). Our secondary aim was to study any possible associations between weight loss after surgery and improvement in patient-related outcome measures (PROMs).

SUMMARY OF BACKGROUND DATA:

Only meager evidence is available as to how surgery for LSS affects weight and whether weight loss is associated with improvement in PROMs after surgery for LSS.

METHODS:

All obese patients who underwent surgery for LSS from January 1, 2006 through June 30, 2008 with a completed 2-year follow-up in SWESPINE were included. Data for weight were collected before surgery and then 1 and 2 years after surgery. The cohort was divided into 3 subclasses (weight stable, weight loss, or weight gain).

RESULTS:

Totally, 538 obese patients were enrolled. Mean weight loss was 1.9 kg (95% confidence interval, 1.5-2.3) 1 year after surgery and 2.0 kg (95% confidence interval, 1.5-2.4) after 2 years after surgery. Only 8% of the patients reported a clinically important weight loss (≥10%). No significant differences in PROMs were observed. The weight-stable group reported a mean improvement of 0.22 (standard deviation, 0.36) in EQ-5D, 14 (18) units in the Oswestry Disability Index, 18 (33) units in back pain (visual analogue scale), and 23 (36) units in leg pain (visual analogue scale). The corresponding changes in the weight-loss group were 0.23 (0.35) in EuroQol 5D, 15 (19) in Oswestry Disability Index, 27 (29) in back pain, and 31 (36) in leg pain.

CONCLUSION:

Modest weight loss was reported 1 and 2 years postsurgery; a small proportion (8%) of these patients reported a clinically important weight loss at the 2-year follow-up. The weight loss was unrelated to changes in PROMs.

LEVEL OF EVIDENCE:

3.

sted, utgiver, år, opplag, sider
2014. Vol. 39, nr 20, s. 1725-1730
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-232356DOI: 10.1097/BRS.0000000000000464ISI: 000342030800021PubMedID: 24921852OAI: oai:DiVA.org:uu-232356DiVA, id: diva2:748431
Tilgjengelig fra: 2014-09-19 Laget: 2014-09-17 Sist oppdatert: 2018-01-11bibliografisk kontrollert
Inngår i avhandling
1. Lumbar spinal stenosis: Body mass index and the patient's perspective
Åpne denne publikasjonen i ny fane eller vindu >>Lumbar spinal stenosis: Body mass index and the patient's perspective
2015 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

During recent decades, lumbar spinal stenosis (LSS) has become the most common indication for spine surgery, a change that coincides with a higher worldwide prevalence of overweight and obesity. Thus, surgical treatment of LSS in the overweight and obese population is common and increasing in scope.

The overall aim of this thesis was to investigate whether body mass index (BMI) is related to the development of LSS, and whether BMI is linked to outcome after surgery for LSS. We further evaluated whether there are specific experiences of LSS from a patient perspective.

Data were obtained for all patients registered in the Swedish Spine Register who had undergone surgery for LSS between January 1, 2006 and June 30, 2008. After adjusting for differences in baseline characteristics, patients with obesity showed both poorer results after surgery and a higher rate of dissatisfaction than patients with normal weight (odds ratio 1.73; 95% confidence interval, CI, 1.36-2.19).

Furthermore, patients with obesity in the cohort reported modest weight loss at follow-up (2.0 kg; 95% CI, 1.5-2.4), and only 8% reported a clinical important weight loss 2 years after surgery.

Our analysis of 389,132 construction workers, showed that overweight (incidence rate ratio, IRR 1.68; 95% CI, 1.54-1.83) and obesity (IRR 2.18; 95% CI, 1.87-2.53) were associated with an increased future risk in developing LSS when compared with patients with normal weight.

To gain insight into the patients' perspective of LSS, we performed interviews with 18 patients who were on a waiting list for LSS surgery. The transcripts, analyzed with content analysis, revealed that living with LSS is a physical, mental and social challenge in which resources to cope with the condition are of major importance.

In summary, obesity is associated with poorer results after surgery, and patients with obesity report modest weight loss during follow-up. In addition, obesity is associated with an increased risk to develop LSS. Our findings revealed that being a patient with LSS, naturally involves considerable suffering and pain, but it also implies being a person with his or her own resources who is able to cope with these adverse conditions.

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis, 2015. s. 70
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1148
Emneord
Antonovsky, back pain, BMI, body mass index, Bygghalsan, cohort study, coping, EQ-5D, excess weight, leg pain, LSS, lumbar spinal stenosis, obesity, ODI Oswestry disability index, overweight, patient-centered, patient-physician relationship, patient-perspective, patient-related-outcome-measure, PROMs, qualitative study, spinal stenosis, salutogenesis, salutogenic, sciatica, spine surgery, suffering, Swedish spine register, Swespine, VAS, weight loss, weight change
HSV kategori
Forskningsprogram
Ortopedi
Identifikatorer
urn:nbn:se:uu:diva-264589 (URN)978-91-554-9376-9 (ISBN)
Disputas
2015-12-04, Rosénsalen, Akademiska barnsjukhuset, ingång 95-96, 751 85, Uppsala, 13:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2015-11-06 Laget: 2015-10-15 Sist oppdatert: 2018-01-11

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