Redefining Surgical Boundaries for Obese Patients? Full Endoscopic Lumbar Discectomy Proves Equally Effective With Shorter Hospital Stay in Obese Patients

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Pre- and postoperative radicular pain box plot.

Table 1

Demographic characteristics endoscopic group.

Characteristic	Obese Endoscopic Patient (N = 71)	Nonobese Endoscopic Patient (N = 54)	Total Endoscopic Population (N = 125)	P
Age, y, mean (min; max)	49.1 (20; 78)	47.2 (24; 74)	48.3 (20; 78)	0.4474
Sex, N (%)				0.0521
Men	36 (50.7)	27 (50.0)	63 (50.4)
Women	35 (49.3)	27 (50.0)	62 (49.6)
BMI, mean (min; max)	33.6 (30.0; 45.1)	24.5 (17.0; 29.7)	29.7 (17.0; 45.1)	0.0032
Duration of pain before surgery,^{^a} mo, mean (min; max)	8.8 (0.50; 120.00)	5.8 (0.15; 24.00)	7.5 (0.15; 120.00)	0.1134
Operative herniation localization, N (%)				0.0579
Posterolateral	54 (76.1)	34 (63.0)	88 (70.4)
Far lateral	14 (19.7)	11 (20.4)	25 (20.0)
Migrated	3 (4.2)	9 (16.7)	12 (9.6)
Operative level, N (%)				0.2224
L1-L2, L2-L3, or L3-L4	14 (19.7)	5 (9.3)	19 (15.2)
L4-L5	36 (50.7)	28 (51.9)	64 (51.2)
L5-S1	21 (29.6)	21 (38.9)	42 (33.6)

Table 2

Preoperative assessment endoscopic group.

Outcome Measure	Obese Endoscopic Patient (N = 71)	Nonobese Endoscopic Patient (N = 54)	Total Endoscopic Population (N = 125)	P
VAS-BP,^{^a} mean (min; max)	4.6 (0.0; 10.0)	3.6 (0.0; 9.2)	4.1 (0.0; 10.0)	0.0078
VAS-L, mean (min; max)	6.9 (2.1; 10.0)	6.6 (2.0; 10.0)	6.7 (2.0; 10.0)	0.3746
ODI,^{^b} mean (median) (min; max)	50.7 (53.5) (10; 96)	47.1 (46.0) (10; 78)	49.1 (50.0) (10; 96)	0.2900
Mean	50.7	47.1	49.1
Median	53.5	46.0	50.0
Min; Max	(10; 96)	(10; 78)	(10; 96)

Abbreviations: ODI, Oswestry Disability Index; VAS-BP, visual analog scale for back pain; VAS-L, visual analog scale for leg pain.
↵a Data were missing for 1 patient in the nonobese endoscopic group.
↵b Data were missing for 1 patient in the obese endoscopic group.

Table 3

Operative and hospital data endoscopic group.

Outcome Measure	Obese Endoscopic Patient (N = 71)	Nonobese Endoscopic Patient (N = 54)	Total Endoscopic Population (N = 125)	P
Operative duration, min, mean (min; max)	70.2 (27; 135)	63.1 (29; 139)	67.1 (27; 139)	0.0971
Approach, n (%)				0.0225
Transforaminal	34 (47.9)	15 (27.8)	49 (39.2)
Interlaminar	37 (52.1)	39 (72.2)	76 (60.8)
Length of hospital stay (night), mean (min; max)	1.7 (1; 7)	1.4 (1; 12)	1.6 (1; 12)	0.0244
3 nights or more, n	10	1	11

Table 4

Complications and reoperation endoscopic group.

Outcome Measure	Obese Endoscopic Patient (N = 71)	Nonobese Endoscopic Patient (N = 54)	Total Endoscopic Population (N = 125)	P
Surgical complications, n (%)				>0.99
Yes	1 (1.4)	1 (1.9)	2 (1.6)
No	70 (98.6)	53 (98.1)	123 (98.4)
Nonsurgical complications, n (%)				0.4320
Yes	0 (0.0)	1 (1.9)	1 (0.8)
No	71 (100.0)	53 (98.1)	124 (99.2)
Re-operation, n (%)				0.6978
Yes	5 (7.0)	2 (3.7)	7 (5.6)
No	66 (93.0)	52 (96.3)	118 (94.4)
Disc herniation recurrence, n (%)				0.2338
Yes	5 (7.0)	1 (1.9)	6 (4.8)
No	66 (93.0)	53 (98.1)	119 (95.2)

Table 5

Clinical results last follow-up in the endoscopic group.

Outcome Measure	Obese Endoscopic Patient (N = 71)	Nonobese Endoscopic Patient (N = 54)	Total Endoscopic Population (N = 125)	P
Delta VAS-BP, N	70	49	119	0.5978
Mean	−1.5	−1.2	−1.4
Median	−1.2	−1.0	−1.2
Min; Max	(−10.0; 3.0)	(−8.2; 5.0)	(−10.0; 5.0)
Delta VAS-L, N	70	49	119	0.2958
Mean	−4.8	−4.2	−4.5
Median	−4.9	−4.8	−4.8
Min; Max	(−10.0; 6.0)	(−10.0; 4.1)	(−10.0; 6.0)
Delta ODI, N	69	45	114	0.8573
Mean	−32.3	−31.0	−31.8
Median	−32.0	−32.0	−32.0
Min; Max	(−80; 10)	(−66; 16)	(−80; 16)
Satisfaction, N (%)	70	48	118	0.5009
Poor	2 (2.9)	1 (2.1)	3 (2.5)
Fair	8 (11.4)	5 (10.4)	13 (11.0)
Good	24 (34.3)	23 (47.9)	47 (39.8)
Excellent	36 (51.4)	19 (39.6)	55 (46.6)

Abbreviations: ODI, Oswestry Disability Index; VAS-BP, visual analog scale for measuring back pain; VAS-L, visual analog scale for measuring leg pain.

Table 6

Obese endoscopic vs obese open surgery.

Outcome Measure	Obese Endoscopic Patient (N = 71)	Obese Open Patients (N = 31)	Total Obese Population (N = 102)	P
Age, y, N	71	31	102	0.0063
Mean	49.1	41.1	46.6
Min; Max	(20; 78)	(23; 68)	(20; 78)
Sex, N	71	31	102
Men, n (%)	36 (50.7)	23 (74.2)	59 (57.8)
Women, n (%)	35 (49.3)	8 (25.8)	43 (42.2)
BMI (kg/m²), N	71	31	102	0.0341
Mean	33.6	32,5	33,2
Min; Max	(30.0; 45.1)	(30.1; 40.8]	(30.0; 45.1)
Duration of pain before surgery, no, N	70	31	101	0.6796
Mean	8.8	7,6	8,5
Min; Max	(0.50; 120.00)	(0.50; 60.0)	(0.50; 120.00)
Operative time, min, N	71	31	102	0.0087
Mean	70.2	59,8	67,0
Min; Max	(27; 135)	(40; 90)	(27; 135)
Hospital stay (nights), N	71	31	102	0.0006
Mean	1.7 (1.2)	2.4 (1.1)	1.9 (1.2)
Min; Max	(1; 7)	(1; 4)	(1; 7)
Satisfaction, N	70	31	101	0.6659
Poor, n (%)	2 (2.9)	0 (0.0)	2 (2.0)
Fair, n (%)	8 (11.4)	4 (12.9)	12 (11.9)
Good, n (%)	24 (34.3)	14 (45.2)	38 (37.6)
Excellent, n (%)	36 (51.4)	13 (41.9)	49 (48.5)
Complications, N	71	31	102	0.51176
Yes, n (%)	1 (1.4)	1 (1.3)	2 (2.0)
No, n (%)	70 (98.6)	30 (96.8)	100 (98.0)
Reoperation, N	71	31	102	0.4489
Yes, n (%)	5 (7.0)	4 (12.9)	9 (8.8)
No, n (%)	66 (93.0)	27 (87.1)	93 (91.2)