Endoscopic lumbar decompression in patients with obesity does not correlate with inferior outcomes.

PURPOSE: Endoscopic spine surgery (ESS) may reduce perioperative risks traditionally associated with obesity in open lumbar procedures. This study evaluated 90-day complications, healthcare utilization, and insurer-payments in obese versus non-obese patients undergoing endoscopic lumbar decompression.

METHODS

A national administrative database was queried for adults undergoing endoscopic lumbar decompression from January 2017 to April 2023. Patients with trauma, neoplasm, or infection within 90-days preoperatively or < 90-day follow-up postoperatively were excluded. Cohorts were stratified by obesity (body mass index > 30 kg/m²). Demographics, 90-day complications (any, severe, minor), and healthcare utilization (emergency department visits, readmissions, physical therapy) were compared using univariable tests and multivariable logistic regression adjusting for age, sex, Elixhauser Comorbidity Index, smoking, type 2 diabetes, hypertension, obstructive sleep apnea, and surgical indication (stenosis vs. disc herniation). Ninety-day insurer payments were compared using a Wilcoxon rank-sum test.

RESULTS

A total of 1,989 patients met criteria (1618 non-obese; 371 obese). On univariable and multivariable analysis, obesity was not associated with increased odds of any 90-day complication or healthcare-utilization outcome. Median (25th quartile, 75th quartile) 90-day insurer-payments were $2563 ($1074, 5124) for non-obese patients and $3310 ($1572, 5784) for obese patients (p = 0.0003).

CONCLUSION

This study demonstrated obesity was not associated with increased odds of 90-day complications or healthcare utilization in the adjusted models. However, obese patients incurred higher insurer-paid costs, underscoring important clinical and policy considerations. As ESS becomes increasingly utilized, future work should examine patient-reported outcomes, longer-term complications, and reoperation-free survival in obese patients as well as in populations with other comorbidities.