Does obesity affect outcomes or complications in the treatment of lumbar disc herniation after open lumbar microdiscectomy? A systematic review and meta-analysis.

Introduction: Obesity is the 4th largest cause of death in Europe and yet its impact on lumbar disc herniation remains controversial. The goal of this study was to systematically review previously published literature on the outcomes and complications of lumbar disc surgery in obese patients. Methods: A literature search was conducted on PubMed, MEDLINE, and Cochrane databases. PRISMA guidelines were adhered to. After careful screening, 5 studies were found eligible for our search question. Differential statistics and random effects models quantified outcomes using odds ratio (dichotomous) and mean differences (continuous), with heterogeneity tests and sensitivity analyses to assess robustness. Results: A total of 15,512 patients were analyzed, of which 2786 were obese. The pooled analyses demonstrated no statistically significant differences between obese and non-obese patients regarding leg pain or disability and MCID was not reached. Obese patients had a 31 % higher risk of complications (OR = 1.31, 95 % CI = [1.06, 1.61], p = 0.013) with increased risk of durotomy (OR = 1.32 (95 % CI = [1.01, 1.72], p = 0.046). The odds of reoperation were not statistically significant in both cohorts. Conclusion: Although both groups profited from lumbar discectomy, obesity was found to increase the risk of surgical complications. Preoperative weight loss should be considered to minimize surgical risks.