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Saturday, October 9, 2010 7:25–8:25 AM General Session: Best Papers 207. Does Obesity Affect Outcomes in the Lumbar Spine Patient? Jeffrey A. Rihn, MD 1 , Kristen Radcliff, MD 1 , Alan S. Hilibrand, MD 1 , Wenyan Zhao, MS 2 , Emily Blood, MS 2 , Alexander R. Vaccaro, MD, PhD 1 , Todd J. Albert, MD 1 , James N. Weinstein, MS, DO 2 ; 1 Thomas Jefferson University Hospital, The Rothman Institute, Philadelphia, PA, USA; 2 The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA BACKGROUND CONTEXT: The affect of obesity on the treatment outcomes for lumbar degenerative disorders remains unknown. PURPOSE: The purpose of this study is to determine if obesity affects treatment outcomes for lumbar intervertebral disc herniation (IDH), steno- sis (SpS) and degenerative spondylolisthesis (DS). STUDY DESIGN/SETTING: As-treated analysis on the combined randomized and observational cohorts from the Spine Patient Outcomes Research Trail (SPORT). PATIENT SAMPLE: Patients enrolled in SPORT for IDH, SpS, or DS treatment. OUTCOME MEASURES: ODI, SF-36 bodily pain (BP) and physical function (PF) scores and secondary outcome measures. METHODS: A comparison was made between patients with a body mass ndex (BMI) less than 30 (n5552 IDH, 373 SpS, 376 DS) and those with a BMI greater than or equal to 30 (n5245 IDH, 261 SpS, 225 DS). Obesity was defined as a BMI greater than or equal to 30. Baseline patient character- istics, intraoperative data, and complications were documented. Primary and secondary outcomes were measured at baseline and regular follow-up time intervals up to 4 years. The difference in improvement from operative and nonoperative treatment (treatment effect) was determined at each follow- up interval. RESULTS: At 4-years follow-up, operative and nonoperative treatment provided improvement in all primary outcome measures over baseline in patients with BMI of less than 30 and greater than or equal to 30. For IDH and SpS patients, there were no differences in the surgical complication or re- operation rates between groups. DS patients with BMI greater than or equal to 30 had a higher postoperative infection rate (5% vs. 1%, p50.05) and twice the reoperation rate at 4-years follow-up (20% vs. 11%, p50.01) than those with BMI less than 30. At 4-years, operative treatment of SpS and DS was equally effective in both BMI groups in terms of the primary outcome mea- sures, with the exception that obese DS patients had worse SF36 PF scores compared to nonobese patients (27.1 vs. 22.6, p50.017). IDH patients with a BMI greater than or equal to 30 did worse with operative treatment than those with BMI less than 30 in all primary outcome measures. With nonoper- ative treatment, SpS patients with BMI greater than or equal to 30 did worse in regards to all three primary outcome measures, and IDH and DS patients with BMI greater than or equal to 30 had similar SF-36 outcomes but worse ODI outcomes. Treatment effects for all lumbar conditions were significant within each BMI group for all primary outcome measures, in favor of surgery. There were no significant differences in the treatment effect for any primary or sec- ondary outcome measures at 4 years between those with BMI less than 30 and greater than or equal to 30, with the exception of the treatment effects for ODI in the SpS patients (-7.4 vs. -13.9, p50.037) and SF-36 PF in the DS patients (14.0 vs. 25.6, p50.004). CONCLUSIONS: Obesity does not affect the clinical outcome of operative treatment for SpS. There are higher rates of infection and reop- eration and a lower SF-36 PF score in obese patients following surgery for DS. Surgery for IDH is not as effective in obese patients. Nonoperative treatment may not be as effective in obese patients with IDH, SpS, or DS. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.255 208. Morbidity and Mortality Associated with the Operative Treatment of Disorders of the Pediatric Spine: A Report from the SRS M&M Committee Kai-Ming Fu, MD, PhD 1 , Justin Smith, MD, PhD 1 , David Hamilton, MD 1 , Joseph H. Perra, MD 2 , David W. Polly, MD 3 , Christopher P. Ames, MD 4 , Sigurd H. Berven, MD 4 , Steven D. Glassman, MD 5 , D. Raymond Knapp, MD 6 , Christopher I. Shaffrey, MD 1 Scoliosis Research Society Morbidity and Mortality Committee 7 ; 1 University of Virginia, Charlottesville, VA, USA; 2 Twin Cities Spine Center, Minneapolis, MN, USA; 3 University of Minnesota, Minneapolis, MN, USA; 4 University of California-San Francisco, San Francisco, CA, USA; 5 Kenton D Leatherman Spine Center, Louisville, KY, USA; 6 Orlando Health, Orlando, FL, USA; 7 SRS, Milwaukee, WI, USA BACKGROUND CONTEXT: Currently few studies regarding complica- tions and mortality associated with operative treatment of pediatric spinal disorders are available to guide the surgeon. PURPOSE: This study provides more detailed complication and mortality data with an analysis of 23,918 pediatric cases reported in the multicenter multi-surgeon Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database. STUDY DESIGN/SETTING: Retrospective review of prospectively collected complications database. PATIENT SAMPLE: 23,918 operative pediatric spine cases reported from 2004–2007. OUTCOME MEASURES: Complications and mortality as reported in the perioperative period. METHODS: The SRS M&M database was queried for the years 2004– 2007. Inclusion criterion was age !18. Cases were categorized by opera- tion type and disease process. Multiple details on the surgical approach, use of neurophysiological monitoring and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Statistical analysis was performed with chi square testing with a P- value of ! 0.05 considered significant. RESULTS: 23,918 patients were included. The mean age was 13 with a standard deviation of 3.6 years. Diseases reported were predominantly deformity including scoliosis (19642), kyphosis (1455), spondylolisthesis (748) and trauma (478). The overall complication rate was 8.5%. Major complications are listed in table 1. Complications and mortality by dis- ease process are listed in table 2. Complications by operation type are listed in table 3. The major complications were due to infection or respi- ratory concerns. Patients undergoing revision (2034) and osteotomy (2787) operations were more likely to suffer a complication and new neu- rological deficit. 31 deaths were reported for an overall rate of 0.13%. Respiratory complications were the most common etiology of mortality (13). 84% (26) of deaths occurred in children undergoing scoliosis correction. CONCLUSIONS: Spinal surgery in children is associated with a range of complications depending on type of operation, but a low mortality rate. Patients undergoing more aggressive corrective procedures for deformity are more likely to suffer complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.256 209. Postoperative Improvement in Health Related Quality of Life: A National Comparison of Surgical Treatment for Focal (1–2 Level) Lumbar Spinal Stenosis Compared to Total Joint Replacement for Osteoarthritis Y. Raja Rampersaud, MD, FRCSC 1 , Eugene Wai, MD, FRCSC 2 , Edward Abraham, MD, FRCSC 3 , David Alexander, MD, FRCSC 4 , 96S Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.

Does Obesity Affect Outcomes in the Lumbar Spine Patient?

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96S Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S

Saturday, October 9, 20107:25–8:25 AM

General Session: Best Papers

207. Does Obesity Affect Outcomes in the Lumbar Spine Patient?

Jeffrey A. Rihn, MD1, Kristen Radcliff, MD1, Alan S. Hilibrand, MD1,

Wenyan Zhao, MS2, Emily Blood, MS2, Alexander R. Vaccaro, MD, PhD1,

Todd J. Albert, MD1, James N. Weinstein, MS, DO2; 1Thomas Jefferson

University Hospital, The Rothman Institute, Philadelphia, PA, USA;2The Dartmouth Institute for Health Policy and Clinical Practice,

Lebanon, NH, USA

BACKGROUND CONTEXT: The affect of obesity on the treatment

outcomes for lumbar degenerative disorders remains unknown.

PURPOSE: The purpose of this study is to determine if obesity affects

treatment outcomes for lumbar intervertebral disc herniation (IDH), steno-

sis (SpS) and degenerative spondylolisthesis (DS).

STUDY DESIGN/SETTING: As-treated analysis on the combined

randomized and observational cohorts from the Spine Patient Outcomes

Research Trail (SPORT).

PATIENT SAMPLE: Patients enrolled in SPORT for IDH, SpS, or DS

treatment.

OUTCOME MEASURES: ODI, SF-36 bodily pain (BP) and physical

function (PF) scores and secondary outcome measures.

METHODS: A comparison was made between patients with a body mass

ndex (BMI) less than 30 (n5552 IDH, 373 SpS, 376 DS) and those with

a BMI greater than or equal to 30 (n5245 IDH, 261 SpS, 225 DS). Obesity

was defined as a BMI greater than or equal to 30. Baseline patient character-

istics, intraoperative data, and complications were documented. Primary and

secondary outcomes were measured at baseline and regular follow-up time

intervals up to 4 years. The difference in improvement from operative and

nonoperative treatment (treatment effect) was determined at each follow-

up interval.

RESULTS: At 4-years follow-up, operative and nonoperative treatment

provided improvement in all primary outcome measures over baseline in

patients with BMI of less than 30 and greater than or equal to 30. For IDH

and SpS patients, there were no differences in the surgical complication or re-

operation rates between groups. DS patients with BMI greater than or equal to

30 had a higher postoperative infection rate (5% vs. 1%, p50.05) and twice

the reoperation rate at 4-years follow-up (20% vs. 11%, p50.01) than those

with BMI less than 30. At 4-years, operative treatment of SpS and DS was

equally effective in both BMI groups in terms of the primary outcome mea-

sures, with the exception that obese DS patients had worse SF36 PF scores

compared to nonobese patients (27.1 vs. 22.6, p50.017). IDH patients with

a BMI greater than or equal to 30 did worse with operative treatment than

those with BMI less than 30 in all primary outcome measures. With nonoper-

ative treatment, SpS patients with BMI greater than or equal to 30 did worse in

regards to all three primary outcome measures, and IDH and DS patients with

BMI greater than or equal to 30 had similar SF-36 outcomes but worse ODI

outcomes. Treatment effects for all lumbar conditions were significant within

each BMI group for all primary outcome measures, in favor of surgery. There

were no significant differences in the treatment effect for any primary or sec-

ondary outcome measures at 4 years between those with BMI less than 30 and

greater than or equal to 30, with the exception of the treatment effects for ODI

in the SpS patients (-7.4 vs. -13.9, p50.037) and SF-36 PF in the DS patients

(14.0 vs. 25.6, p50.004).

CONCLUSIONS: Obesity does not affect the clinical outcome of

operative treatment for SpS. There are higher rates of infection and reop-

eration and a lower SF-36 PF score in obese patients following surgery for

DS. Surgery for IDH is not as effective in obese patients. Nonoperative

treatment may not be as effective in obese patients with IDH, SpS, or DS.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.255

All referenced figures and tables will be available at the Annual Mee

208. Morbidity and Mortality Associated with the Operative

Treatment of Disorders of the Pediatric Spine: A Report

from the SRS M&M Committee

Kai-Ming Fu, MD, PhD1, Justin Smith, MD, PhD1, David Hamilton, MD1,

Joseph H. Perra, MD2, David W. Polly, MD3, Christopher P. Ames, MD4,

Sigurd H. Berven, MD4, Steven D. Glassman, MD5,

D. Raymond Knapp, MD6, Christopher I. Shaffrey, MD1

Scoliosis Research Society Morbidity and Mortality Committee7;1University of Virginia, Charlottesville, VA, USA; 2Twin Cities

Spine Center, Minneapolis, MN, USA; 3University of Minnesota,

Minneapolis, MN, USA; 4University of California-San Francisco,

San Francisco, CA, USA; 5Kenton D Leatherman Spine Center,

Louisville, KY, USA; 6Orlando Health, Orlando, FL, USA; 7SRS,

Milwaukee, WI, USA

BACKGROUND CONTEXT: Currently few studies regarding complica-

tions and mortality associated with operative treatment of pediatric spinal

disorders are available to guide the surgeon.

PURPOSE: This study provides more detailed complication and mortality

data with an analysis of 23,918 pediatric cases reported in the multicenter

multi-surgeon Scoliosis Research Society (SRS) Morbidity and Mortality

(M&M) database.

STUDY DESIGN/SETTING: Retrospective review of prospectively

collected complications database.

PATIENT SAMPLE: 23,918 operative pediatric spine cases reported

from 2004–2007.

OUTCOME MEASURES: Complications and mortality as reported in

the perioperative period.

METHODS: The SRS M&M database was queried for the years 2004–

2007. Inclusion criterion was age!18. Cases were categorized by opera-

tion type and disease process. Multiple details on the surgical approach,

use of neurophysiological monitoring and type of instrumentation were

recorded. Major perioperative complications and deaths were evaluated.

Statistical analysis was performed with chi square testing with a P- value

of!0.05 considered significant.

RESULTS: 23,918 patients were included. The mean age was 13 with

a standard deviation of 3.6 years. Diseases reported were predominantly

deformity including scoliosis (19642), kyphosis (1455), spondylolisthesis

(748) and trauma (478). The overall complication rate was 8.5%. Major

complications are listed in table 1. Complications and mortality by dis-

ease process are listed in table 2. Complications by operation type are

listed in table 3. The major complications were due to infection or respi-

ratory concerns. Patients undergoing revision (2034) and osteotomy

(2787) operations were more likely to suffer a complication and new neu-

rological deficit. 31 deaths were reported for an overall rate of 0.13%.

Respiratory complications were the most common etiology of mortality

(13). 84% (26) of deaths occurred in children undergoing scoliosis

correction.

CONCLUSIONS: Spinal surgery in children is associated with a range of

complications depending on type of operation, but a low mortality rate.

Patients undergoing more aggressive corrective procedures for deformity

are more likely to suffer complications.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.256

209. Postoperative Improvement in Health Related Quality of Life:

A National Comparison of Surgical Treatment for Focal (1–2 Level)

Lumbar Spinal Stenosis Compared to Total Joint Replacement for

Osteoarthritis

Y. Raja Rampersaud, MD, FRCSC1, Eugene Wai, MD, FRCSC2,

Edward Abraham, MD, FRCSC3, David Alexander, MD, FRCSC4,

ting and will be included with the post-meeting online content.