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Purpose <p>To determine whether obesity (body mass index ≥ 30&#xa0;kg/m²) is associated with differences in complication rates, operative parameters, pain/disability outcomes, and hospital length of stay after anterior lumbar interbody fusion (ALIF) for degenerative lumbar pathology.</p> Methods <p>We conducted a systematic review and Bayesian meta-analysis following PRISMA 2020. PubMed, Embase, and Scopus were searched from January 1, 2010, to April 1, 2025, for retrospective or prospective studies comparing obese versus non-obese ALIF cohorts. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle–Ottawa Scale. A hierarchical Bayesian framework synthesized continuous outcomes (Visual Analog Scale [VAS] for back/leg pain, Oswestry Disability Index [ODI], hospital stay, blood loss, operative time) and binomial complication data. Sensitivity analyses excluded a large supine-position study and varied prior distributions.</p> Results <p>Twenty-two studies met inclusion criteria. Obesity was associated with higher odds of complications (median odds ratio ≈ 1.5; 95% credible interval [CrI] 1.1–2.0) and longer hospital stay (mean difference ≈ + 1.3 days; 95% CrI + 0.8 to + 1.9). Postoperative pain modestly favored non-obese patients: back pain mean difference ≈ + 0.4 points (95% CrI 0.0 to + 0.8) and leg pain ≈ + 0.8 points (95% CrI + 0.4 to + 1.2) in obese cohorts. ODI effects showed substantial between-study heterogeneity. Blood loss and operative time findings were inconclusive due to high variability across centers. Sensitivity analyses preserved effect direction.</p> Conclusion <p>Obesity modestly increases complication risk and length of stay after ALIF, yet obese patients still achieve meaningful postoperative pain relief. Preoperative risk-factor optimization, careful exposure strategies, and multidisciplinary perioperative care may mitigate these risks. Further prospective research with standardized outcome definitions is warranted to refine patient selection and surgical technique.</p>

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Obesity and anterior lumbar interbody fusion: a bayesian meta-analysis of complications and outcomes

  • 期刊论文

  • 发表日期：

    2025年12月22日

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  • Samir Smajic,
  • Koroush Kabir,
  • Ümit Mert,
  • Markus Konieczny,
  • Ghasemi Amir,
  • Raffael Scrofani,
  • Filippo Migliorini,
  • Anel Dracic

摘要

Purpose

To determine whether obesity (body mass index ≥ 30 kg/m²) is associated with differences in complication rates, operative parameters, pain/disability outcomes, and hospital length of stay after anterior lumbar interbody fusion (ALIF) for degenerative lumbar pathology.

Methods

We conducted a systematic review and Bayesian meta-analysis following PRISMA 2020. PubMed, Embase, and Scopus were searched from January 1, 2010, to April 1, 2025, for retrospective or prospective studies comparing obese versus non-obese ALIF cohorts. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle–Ottawa Scale. A hierarchical Bayesian framework synthesized continuous outcomes (Visual Analog Scale [VAS] for back/leg pain, Oswestry Disability Index [ODI], hospital stay, blood loss, operative time) and binomial complication data. Sensitivity analyses excluded a large supine-position study and varied prior distributions.

Results

Twenty-two studies met inclusion criteria. Obesity was associated with higher odds of complications (median odds ratio ≈ 1.5; 95% credible interval [CrI] 1.1–2.0) and longer hospital stay (mean difference ≈ + 1.3 days; 95% CrI + 0.8 to + 1.9). Postoperative pain modestly favored non-obese patients: back pain mean difference ≈ + 0.4 points (95% CrI 0.0 to + 0.8) and leg pain ≈ + 0.8 points (95% CrI + 0.4 to + 1.2) in obese cohorts. ODI effects showed substantial between-study heterogeneity. Blood loss and operative time findings were inconclusive due to high variability across centers. Sensitivity analyses preserved effect direction.

Conclusion

Obesity modestly increases complication risk and length of stay after ALIF, yet obese patients still achieve meaningful postoperative pain relief. Preoperative risk-factor optimization, careful exposure strategies, and multidisciplinary perioperative care may mitigate these risks. Further prospective research with standardized outcome definitions is warranted to refine patient selection and surgical technique.