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

Study Design: A meta-analysis study. Objective: This meta-analysis evaluates the difference in surgical outcomes between obese and nonobese 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. Materials and Methods: We conducted a comprehensive search of PubMed, Cochrane, and Google Scholar (pages 1–20) through June of 2024. The surgical outcomes assessed included postoperative complications, revision rates, wound infections, thromboembolic events, implant-related complications, and nonhome 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 the inclusion criteria. Nonobese patients exhibited a lower rate of implant-related complications [odds ratio (OR)=0.25; 95% CI: 0.12–0.52, P =0.0002] and nonhome discharge (OR=0.52; 95% CI: 0.32–0.84, P =0.007). In addition, nonobese patients had reduced LOS (MD=−0.29; 95% CI: −0.53 to −0.05, P =0.02) and EBL (SMD=−0.68; 95% CI: −1.19 to −0.18, P =0.008). No statistically significant differences were observed for the remaining outcomes. Conclusion: Nonobese 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 with their obese counterparts.