Do Obese Patients Have Worse Outcomes in Adult Spinal Deformity Surgeries? A Meta-Analysis

Study Design: Meta-Analysis Objective: This meta-analysis evaluates the difference in surgical outcomes between obese and non-obese patients undergoing adult spinal deformity (ASD) corrective surgery. Background: ASD encompasses a wide range of debilitating spinal abnormalities. Concurrently, obesity is on the rise globally and has been shown to influence the outcomes of ASD management. The relationship between obesity and surgical outcomes in ASD has been the focus of recent studies, yielding various results. Methods: We conducted a comprehensive search of PubMed, Cochrane, and Google Scholar (page 1-20) through June of 2024. The surgical outcomes assessed included post-operative complications, revision rates, wound infections, thromboembolic events, implant-related complications, and non-home discharge. Surgical parameters such as operative time, length of stay (LOS), and estimated blood loss (EBL), as well as functional outcomes like the Oswestry Disability Index (ODI) and pain scores were analyzed. Results: Nine studies met inclusion criteria. Non-obese patients exhibited a lower rate of implant-related complications (OR=0.25; 95% CI: 0.12–0.52, P =0.0002) and non-home discharge (OR=0.52; 95% CI: 0.32–0.84, P =0.007). Additionally, non-obese patients had reduced LOS (MD=-0.29; 95% CI: -0.53 – -0.05, P =0.02) and EBL (SMD=-0.68; 95% CI: -1.19 – -0.18, P =0.008). No statistically significant differences were observed for the remaining outcomes. Conclusion: Non-obese patients undergoing ASD corrective surgery are associated with fewer implant-related complications, a lower EBL, shorter LOS, and a higher likelihood of being discharged home compared to their obese counterparts.