273 Minimal Differences in Surgical Outcomes Exist Between Obese and Non-Obese Patients Following Endoscopic Decompression Surgery

INTRODUCTION: Obesity's impact on postoperative complications and poor functional outcomes in spine surgery is well-documented. It affects both the technical difficulty of lumbar spine surgery and systemic health. The increased adipose tissue around the spine necessitates extensive soft tissue dissection. Minimally invasive endoscopic surgery may reduce these complications. This study investigates the effects of BMI on outcomes in endoscopic spine surgery, comparing clinical outcomes in patients with BMI > 30 vs. BMI < 30 undergoing endoscopic lumbar decompression surgery. METHODS: We identified all individuals who underwent single-level lumbar nerve root decompression utilizing both endoscopic and open approaches at a multi-hospital academic center between 2019 and 2023. Comprehensive data on each patient was collected, including each patient’s demographics, length-of-stay (LOS), demographics, surgical time, operative time, Charlson comorbidity index (CCI), and patient-reported outcome measures (PROMs). Differences in outcome measures were adjusted for demographic variations and evaluated using Student’s t-tests. RESULTS: The study cohort comprised 110 patients: 39 non-obese and 71 obese. Non-obese patients showed significant improvement in PROMIS PF scores (3.39 vs. -1.5, p=0.047), but there were no statistically significant differences in PROMIS PI, PROMIS Depression, EQ5D, LOS, reoperation rates, CSF leaks, or nerve injury. No infections or wound complications occurred in either group. CONCLUSIONS: Our findings suggest that obesity does not negatively impact endoscopic nerve decompression outcomes for lumbar radiculopathy. In particular, improved patient-reported physical function among non-obese patients was the only noteworthy distinction between the two groups. Collectively, since there are minimal disparities in other metrics when comparing obese to non-obese patients, our results suggest that an endoscopic approach may mitigate the surgical risk that obesity portends. Future studies with larger cohorts will help further elucidate our finding.