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Obese patients report modest weight loss after surgery for lumbar spinal stenosis: a study from the Swedish spine register
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2014 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 39, no 20, 1725-1730 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2014. Vol. 39, no 20, 1725-1730 p.
National Category
Orthopedics
Identifiers
URN: urn:nbn:se:uu:diva-232356DOI: 10.1097/BRS.0000000000000464ISI: 000342030800021PubMedID: 24921852OAI: oai:DiVA.org:uu-232356DiVA: diva2:748431
Available from: 2014-09-19 Created: 2014-09-17 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Lumbar spinal stenosis: Body mass index and the patient's perspective
Open this publication in new window or tab >>Lumbar spinal stenosis: Body mass index and the patient's perspective
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 70 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1148
Keyword
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
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-264589 (URN)978-91-554-9376-9 (ISBN)
Public defence
2015-12-04, Rosénsalen, Akademiska barnsjukhuset, ingång 95-96, 751 85, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-11-06 Created: 2015-10-15 Last updated: 2016-04-20

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Knutsson, BjörnMichaëlsson, KarlSandén, Bengt

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