Comparison of perioperative outcomes following open versus minimally invasive transforaminal lumbar interbody fusion in obese patients

Object Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) has proven to be effective in the treatment of spondylolisthesis and degenerative disc disease (DDD). Compared with the traditional open TLIF, the MI procedure has been associated with less blood loss, less postoperative pain, and a shorter hospital stay. However, it is uncertain whether the advantages of an MI TLIF also apply specifically to obese patients. This study was dedicated to evaluating whether obese patients reap the perioperative benefits similar to those seen in patients with normal body mass index (BMI) when undergoing MI TLIF. Methods Obese patients—that is, those with a BMI of at least 30 kg/m2—who had undergone single-level TLIF were retrospectively identified and categorized according to BMI: Class I obesity, BMI 30.0–34.9 kg/m2; Class II obesity, BMI 35.0–39.9 kg/m2; or Class III obesity, BMI ≥ 40.0 kg/m2. In each obesity class, patients were stratified by TLIF approach, that is, open versus MI. Perioperative outcomes, including intraoperative estimated blood loss (EBL), complications (overall, intraoperative, and 30-day postoperative), and hospital length of stay (LOS), were compared. The chi-square test, Fisher exact test, or 2-tailed Student t-test were used when appropriate. Results One hundred twenty-seven patients were included in the final analysis; 49 underwent open TLIF and 78 underwent MI TLIF. Sixty-one patients had Class I obesity (23 open and 38 MI TLIF); 45 patients, Class II (19 open and 26 MI); and 21 patients, Class III (7 open and 14 MI). Overall, mean EBL was 397.2 ml and mean hospital LOS was 3.7 days. Minimally invasive TLIF was associated with significantly less EBL and a shorter hospital stay than open TLIF when all patients were evaluated as a single cohort and within individual obesity classes. Overall, the complication rate was 18.1%. Minimally invasive TLIF was associated with a significantly lower total complication rate (11.5% MI vs 28.6% open) and intraoperative complication rate (3.8% MI vs 16.3% open) as compared with open TLIF. When stratified by obesity class, MI TLIF was still associated with lower rates of total and intraoperative complications. This effect was most profound and statistically significant in patients with Class III obesity (42.9% open vs 7.1% MI). Conclusions Minimally invasive TLIF offers obese patients perioperative benefits similar to those seen in patients with normal BMI who undergo the same procedure. These benefits include less EBL, a shorter hospital stay, and potentially fewer complications compared with open TLIF. Additional large retrospective studies and randomized prospective studies are needed to verify these findings.

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Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study

Surgical Endoscopy ◽

10.1007/s00464-021-08434-w ◽

2021 ◽

Author(s):

Andrea Ruzzenente ◽

◽

Andrea Ciangherotti ◽

Luca Aldrighetti ◽

Giuseppe Maria Ettorre ◽

...

Keyword(s):

Minimally Invasive ◽

Liver Metastases ◽

Hospital Stay ◽

Complication Rate ◽

Liver Surgery ◽

Colorectal Liver Metastases ◽

Caudate Lobe ◽

Open Group ◽

Perioperative Outcomes ◽

Minimally Invasive Liver Surgery

Abstract Background Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.

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Outcomes Amongst Obesity Class I, II, and III Patients Undergoing Minimally Invasive Aortic Valve Replacement

10.22541/au.163254802.28999649/v1 ◽

2021 ◽

Author(s):

Marlena Sabatino ◽

NaYoung Yang ◽

Fady Soliman ◽

Joshua Chao ◽

ALEXIS OKOH ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Class Ii ◽

Valve Surgery ◽

Class I ◽

Obese Patients ◽

Class Iii ◽

Obesity Class

Background: Minimally invasive heart valve surgery has previously been shown to be safe and feasible in obese patients. Within this population, we investigated the effect of obesity class on the patient outcomes of minimally invasive aortic valve replacement (mini-AVR). Methods: A single center retrospective cohort study of consecutive patients with obese body mass indices (BMIs) who underwent mini-AVR between 2012 and 2018. Patients were stratified into 3 groups according to Centers for Disease Control and Prevention adult obesity classifications: Class I (BMI 30.0 to < 35.0), Class II (BMI 35.0 to < 40.0), and Class III (BMI ≥ 40.0). The primary outcomes were postoperative length of stay (LOS), 30-day mortality within, and cost. Results: Amongst 182 obese patients who underwent mini-AVR, LOS (Class I 4 [3-6] vs. Class II 4 [3-6] vs. Class III 5 [4-6] days; p=0.098) and costs (Class I $24,487 [$20,199-$27.480] vs. Class II $22,921 [$20,433-$27,740] vs. Class III $23,886 [$20,063-$33,800] USD; p=0.860) did not differ between obesity class cohorts. Postoperative 30-day mortality (Class I 2.83% [n=2] vs. Class II 0% [n=0] vs. Class III 0% [n=0]; p=0.763) was limited by an insufficient sample size relative to a low event rate but did not differ between patient cohorts. Conclusions: Mini-AVR is safe and feasible to perform for obese patients regardless of their obesity class. Patients with obesity should be afforded the option of minimally invasive aortic valve surgery regardless of their obesity class.

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Open versus Minimally invasive transforaminal lumbar interbody fusion: Intermediate outcomes in overweight and obese patients

Journal of Musculoskeletal Surgery and Research ◽

10.4103/jmsr.jmsr_9_20 ◽

2020 ◽

Vol 4 (2) ◽

pp. 82

Author(s):

MuathM Alswat ◽

MohammedA Khashab ◽

BasilS Alsofiani ◽

OsamahA Algamedi ◽

MahdiF Shulan

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Obese Patients ◽

Lumbar Interbody Fusion ◽

Intermediate Outcomes ◽

Open Versus

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Comparative Analysis of Open Versus Minimally Invasive Techniques for Posterior or Transforaminal Lumbar Interbody Fusion

Evidence for Neurosurgery ◽

10.1007/978-3-030-16323-5_17 ◽

2019 ◽

pp. 257-276

Author(s):

Lee Hwang ◽

Vikram Chakravarthy ◽

William Kemp ◽

Michael Steinmetz ◽

Edward Benzel

Keyword(s):

Comparative Analysis ◽

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Minimally Invasive Techniques ◽

Open Versus ◽

Invasive Techniques

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Ovarian reserve in women with obesity

Obesity and metabolism ◽

10.14341/omet9862 ◽

2019 ◽

Vol 16 (3) ◽

pp. 69-75

Author(s):

Olga R. Grigoryan ◽

Robert K. Mikheev ◽

Elena N. Andreeva ◽

Ivan I. Dedov

Keyword(s):

Ovarian Reserve ◽

Antral Follicle ◽

Reproductive Age ◽

Reference Ranges ◽

Obese Patients ◽

Class Iii ◽

Multicenter Studies ◽

Ovarian Volume ◽

Obesity Class ◽

Significant Difference

BACKGROUND: One of the consequences of obesity for the female body is a decrease in fertility. It is shown that impaired reproductive function in obese patients can be associated, in particular, with a decrease in ovarian reserve. AIMS: To evaluate the ovarian reserve function in female patients of reproductive age with different classes of obesity in comparison with women without obesity. MATERIALS AND METHODS: This study evaluated 320 caucasian women, age 20-30 years, without obesity (BMI30, n=80) and with obesity WHO class I-III (n=80 per class). Anthropometrics, serum concentrations of anti-Mullerian hormone (AMH), inhibin B, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and testosterone were compared on the 2-3 day of menstrual cycle as ovarian volume and antral follicle count (AFC). RESULTS: We reveal statistically significant difference in following parameters in normal BMI women in comparison with obesity women: AMH, testosterone, ovarian volume and AFC. Moreover, we reveal significant difference between patients with different WHO class of obesity. But even in class III obesity parameters remained within reference ranges. CONCLUSIONS: Ovarian reserve function parameters progressively decrease with increase of obesity class in subjects, but ovarian reserve parameters were in normal reference range even in class III obese patients. Further large randomized multicenter studies are required to find influence of obesity in relation to ethnicity and other factors to ovarian reserve function.

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Editorial: Perioperative outcomes and adverse events of minimally invasive surgery during transforaminal lumbar interbody fusion/posterior lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine15238 ◽

2016 ◽

Vol 24 (3) ◽

pp. 413-415

Author(s):

Robert F. Heary ◽

Michael G. Kaiser

Keyword(s):

Minimally Invasive Surgery ◽

Adverse Events ◽

Minimally Invasive ◽

Invasive Surgery ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Perioperative Outcomes ◽

Lumbar Interbody Fusion

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Impact of morbid obesity (BMI > 40 kg/m2) on complication rate and outcome following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2019.02.004 ◽

2019 ◽

Vol 178 ◽

pp. 82-85 ◽

Cited By ~ 4

Author(s):

Marie T. Krüger ◽

Yashar Naseri ◽

Marc Hohenhaus ◽

Ulrich Hubbe ◽

Christoph Scholz ◽

...

Keyword(s):

Morbid Obesity ◽

Minimally Invasive ◽

Complication Rate ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion

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A National Contemporary Analysis of Perioperative Outcomes of Open versus Minimally Invasive Sacrocolpopexy

The Journal of Urology ◽

10.1016/j.juro.2018.03.131 ◽

2018 ◽

Vol 200 (4) ◽

pp. 862-867 ◽

Cited By ~ 19

Author(s):

Brian J. Linder ◽

John A. Occhino ◽

Elizabeth B. Habermann ◽

Amy E. Glasgow ◽

Katherine A. Bews ◽

...

Keyword(s):

Minimally Invasive ◽

Perioperative Outcomes ◽

Open Versus

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Open versus minimally invasive decompression for low-grade spondylolisthesis: analysis from the Quality Outcomes Database

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine191239 ◽

2020 ◽

Vol 33 (3) ◽

pp. 349-359

Author(s):

Erica F. Bisson ◽

Praveen V. Mummaneni ◽

Michael S. Virk ◽

John Knightly ◽

Mohammed Ali Alvi ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Perioperative Outcomes ◽

Low Grade ◽

Quality Outcomes ◽

Lumbar Decompression ◽

Patient Reported ◽

Open Versus ◽

The Impact

OBJECTIVELumbar decompression without arthrodesis remains a potential treatment option for cases of low-grade spondylolisthesis (i.e., Meyerding grade I). Minimally invasive surgery (MIS) techniques have recently been increasingly used because of their touted benefits including lower operating time, blood loss, and length of stay. Herein, the authors analyzed patients enrolled in a national surgical registry and compared the baseline characteristics and postoperative clinical and patient-reported outcomes (PROs) between patients undergoing open versus MIS lumbar decompression.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Among more than 200 participating sites, the 12 with the highest enrollment of patients into the lumbar spine module came together to initiate a focused project to assess the impact of fusion on PROs in patients undergoing surgery for grade I lumbar spondylolisthesis. For the current study, only patients in this cohort from the 12 highest-enrolling sites who underwent a decompression alone were evaluated and classified as open or MIS (tubular decompression). Outcomes of interest included PROs at 2 years; perioperative outcomes such as blood loss and complications; and postoperative outcomes such as length of stay, discharge disposition, and reoperations.RESULTSA total of 140 patients undergoing decompression were selected, of whom 71 (50.7%) underwent MIS and 69 (49.3%) underwent an open decompression. On univariate analysis, the authors observed no significant differences between the 2 groups in terms of PROs at 2-year follow-up, including back pain, leg pain, Oswestry Disability Index score, EQ-5D score, and patient satisfaction. On multivariable analysis, compared to MIS, open decompression was associated with higher satisfaction (OR 7.5, 95% CI 2.41–23.2, p = 0.0005). Patients undergoing MIS decompression had a significantly shorter length of stay compared to the open group (0.68 days [SD 1.18] vs 1.83 days [SD 1.618], p < 0.001).CONCLUSIONSIn this multiinstitutional prospective study, the authors found comparable PROs as well as clinical outcomes at 2 years between groups of patients undergoing open or MIS decompression for low-grade spondylolisthesis.

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