Endoscopic lumbar decompression in patients with obesity  does not correlate with inferior outcomes

Purpose: Endoscopic spine surgery may reduce perioperative risks previously associated with obesity in open surgery. The present study aimed to evaluate 90-day outcomes and overall insurer-payments in obese versus non-obese patients undergoing endoscopic lumbar decompression. Methods: The January 2010–April 2023 PearlDiver M170 database was queried for adults patients undergoing endoscopic lumbar decompression. Exclusion criteria included diagnosis of trauma, neoplasm, or infection of the spine within 90 days preoperatively or those with postoperative follow-up of < 90 days. Cohorts were stratified by obesity (body mass index > 30 kg/m²). Demographics, 90-day complications (any, severe, and minor adverse events), and healthcare utilization (emergency department visits, readmissions, and physical therapy) were compared with univariable analyses and multivariable logistic regression adjusted for age, sex, Elixhauser Comorbidity Index, and smoking status. Ninety-day insurer overall payments were compared using a Wilcoxon rank-sum test. Statistical significance was set at p < 0.05. Results: A total of 1,618 non-obese (81.3%) and 371 obese (18.7%) patients were identified. In both univariable and multivariable analyses, no significant differences in 90-day complication rates or healthcare utilization metrics were observed between cohorts. Median (25th quartile, 75th quartile) 90-day insurer-payments were $2,563 ($1,074, 5,124) for non-obese patients and $3,310 ($1,572, 5,784) for obese patients (p = 0.003). Conclusion: Among a robust, national cohort of patients in the US undergoing endoscopic lumbar decompression, the current study found obesity did not correlate with postoperative outcomes. These findings suggest the safe use of endoscopic spine intervention for obese populations. Further research should evaluate patient-reported outcomes as adoption of endoscopic techniques expands.