SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Obesity and anterior lumbar interbody fusion: a bayesian meta-analysis of complications and outcomes.
Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo 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.
methodsWe 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.
resultsTwenty-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.
conclusionObesity 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.
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