Impact of obesity on patient-reported outcome measures and complications following anterior cervical surgery for cervical spondylosis: A cohort study Of 7,993 patients

Cervical spondylosis is a common degenerative condition of the cervical spine that often requires surgical intervention. Obesity is a modifiable risk factor that may influence surgical outcomes, including those in cervical spine procedures. This study aims to examine the relationship between obesity and patient-reported outcomes, including pain, function, and return to work, following anterior surgery for cervical spondylosis. We conducted a retrospective longitudinal cohort study using data from the Swedish National Spine Register (Swespine) on patients who underwent anterior cervical surgery for cervical spondylosis between 2006 and 2021. We compared preoperative and postoperative pain, function, and quality of life, between obese and non-obese patients. A total of 7,933 patients were included in the analysis. Baseline characteristics differed between obese and non-obese groups, with obese patients reporting lower preoperative baseline health-related quality of life and higher disability scores (p < 0.05). Nonetheless, at 1-year follow-up, both groups showed similar improvements in neck pain, arm pain, disability (NDI), and quality of life (EQ-5D index and EQ VAS). However, obese patients were less likely to experience complete arm pain relief and had slightly poorer recovery in fine motor skills. Additionally, obese patients had lower rates of return to work (33% vs. 28%, p = 0.003). On subgroup analysis, patients with severe or morbid obesity were found to have significantly higher risks of overall complications following surgery when compared to non-obese patients (3.4% vs. 1.4%; p = 0.009). Although obese patients were worse at baseline, they showed similar improvements in pain, function, and quality of life compared to non-obese patients following anterior cervical surgery. Our findings suggest that obesity should not preclude surgical intervention, as obese patients have the potential for significant postoperative recovery, although attention when treating severely or morbidly obese patients is warranted.