How the Utilization of Body Mass Index Cutoffs for Determining Surgical Eligibility in Patients Undergoing Lumbar Decompression Affects Health Care Gender Disparities

Wednesday, February 21, 2024

Presenting Author(s)

Carly Weber-Levine, MS (she/her/hers)

Medical Student
Johns Hopkins University School of Medicine
East Setauket, NY, US

Co-Author(s)

KA

Kimberly Ashayeri, MD

Neurosurgery Spine Fellow
Johns Hopkins University School of Medicine
New York, NY, US
Daniel Davidar, MD

Research Fellow
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Andrew M. Hersh, B.S.

Medical Student
John Hopkins Medical School
Baltimore, MD, US
Kelly Jiang, n/a

Medical Student
Johns Hopkins University School of Medicine
Baltimore, MD, US
Nicholas Theodore, MD, MS (he/him/his)

Director, Neurosurgical Spine Center; Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, MD, US

Disclosure(s):

Carly Weber-Levine, MS: No financial relationships to disclose

Andrew M. Hersh, AB: No financial relationships to disclose

Introduction: Body mass index (BMI) cutoffs have historically been used for guiding surgical eligibility with inconsistent results in the effects of these cutoffs on surgical outcomes. Accordingly, at the 2023 American Medical Association (AMA) Annual Meeting, the delegates discussed the discrimination that can result in patients of different races, ethnic groups, or sexes when BMI is used in this way. In this study, we examine the role of BMI in determining surgical eligibility in patients of different sexes undergoing lumbar decompression.

Methods: TriNetX Research Network, a national federated health network, was queried for patients with lumbar spinal stenosis (ICD-10 M48.06). Patients were included if they were at least 65 years old, received a lumbar MRI (CPT 72148), and had Medicare documentation of BMI, with normal or overweight defined as BMI 18.5-25 or > 25 kg/m2, respectively (HCPCS G8420, G8417). Lumbar decompression rates were compared between groups (CPT 63005, 63017, 63030, 63042, 63047). Patients were propensity score matched for age and race. A two-tailed t-test was used to compare BMI among the different groups.

Results: 1,843,887 patients were identified as having age >= 65 years, lumbar spinal stenosis, and lumbar MRI. After matching for age and race, 1,578,564 patients were included for further analysis. Of these patients, an average 6.8% of females underwent lumbar decompression compared to 9.8% in males (p < 0.0001). In male patients, there was no difference in the percentage of patients that underwent lumbar decompression when comparing normal to high BMI (7.2% versus 7%, respectively, p=0.13). In female patients, however, women with higher BMIs were less likely to undergo lumbar decompression compared to those with normal BMIs (4.8% versus 5%, respectively, p=0.04).

Conclusion : Our study found that utilizing BMI cutoffs disproportionately affected the surgical eligibility of women, with no effect on male patients. While utilizing BMI cutoffs may have some clinical utility, providers should be cognizant of the disparities they can introduce.