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Study Design: Prospective observational study. Objectives: To determine whether body mass index (BMI) and abdominal girth are reliable predictors of wound depth and operative duration at lumbar discectomy, to compare the duration of traineeand consultant-performed cases, and to assess the role of patient body habitus when selecting cases for training opportunities. Methods: Pre-operative height and weight, abdominal girth in knee-chest position, and intra-operative wound measurements were taken. Operative duration was recorded using theatre management software. Patients undergoing single-level lumbar discectomy were selected, n=29, M:F ratio 18:11. Mean age was 47.2 years (range 18-83). Discectomy level: L2/3 (1); L3/4 (1), L4/5 (18); L5/S1 (9). Results: Mean BMI was 30.4kg/m (19.7-47.2), abdominal girth 106cm (48-154), wound length 5.4cm (4.56.5), subcutaneous fat depth 1.9cm (0.5-5.2), muscle depth 3.2cm (2.0-4.2), total wound depth 5.0cm (3.59.0), operation duration 47 minutes (24-82). Fifteen patients were clinically obese (BMI >30 kg/m). Fifteen cases were trainee-performed and fourteen consultant-performed. Mean trainee operative duration was 50 minutes (24-77). Mean consultant operative duration was 45 minutes (24-82). Of the cases with BMI >30kg/m, eight were trainee-performed and seven consultant-performed. Subcutaneous fat depth, muscle depth and total wound depth were associated with increased operative duration. BMI, abdominal girth, discectomy level and trainee-performed cases were not significantly associated with increased operative duration. Conclusions: Over half of the study patients were clinically obese. BMI and abdominal girth are not reliable predictors of operative difficulty as measured by operative duration. Lumbar discectomy in obese individuals is an appropriate training case. © 2018 Dallan P Dargan. Hosting by Science Repository. All rights reserved.

Lumbar discectomy: should patient body mass index and abdominal girth be considered when selecting cases suitable for training opportunities? A prospective observational study