Impact of Obesity on Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgeries: A Systematic Review and Meta-Analysis.

Abstract

To evaluate the impact of obesity on various outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (TLIF) surgeries. PubMed, Scopus, Embase, and Cochrane Library databases were screened for studies reporting outcomes in obese and nonobese patients undergoing TLIF surgeries. Studies reporting operative time, estimated blood loss, length of hospital stay, incidence of pseudoarthrosis, Oswestry Disability Index (ODI) scores, pain scores (Visual Analog Scale, VAS), and PROMIS PF scores were included. A qualitative and quantitative analysis was performed to calculate mean differences or odds ratios (ORs) using random-effects models. Fourteen good-quality studies were included in this review, with a combined sample size of 4,889 participants. The analysis revealed that patients with obesity had slightly longer operative times compared to patients with normal weight, with a mean difference of 14.87 minutes, though not significant. Similarly, morbidly obese patients had a mean difference of 21.44 minutes in operative time. Estimated blood loss was comparable in both groups. However, morbidly obese patients had longer hospital stays, with a mean difference of 8.18 days and obese patients have 20% higher odds of experiencing complications compared to nonobese patients. The incidence of pseudoarthrosis, ODI scores, or pain scores (VAS back and leg) were similar in obese and normal weight patients. Obesity, particularly morbid obesity, may have an impact on certain outcomes in patients undergoing minimally invasive TLIF surgeries. Morbidly obese patients tend to have significantly longer operative times with significantly longer hospital stays than nonobese patients.