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Outcomes and Complications of Diabetes Mellitus on Patients Undergoing Degenerative Lumbar Spine Surgery

Guzman, Javier Z. BS*; Iatridis, James C. PhD*; Skovrlj, Branko MD; Cutler, Holt S. BSc*; Hecht, Andrew C. MD*; Qureshi, Sheeraz A. MD, MBA*; Cho, Samuel K. MD

doi: 10.1097/BRS.0000000000000482
Outcomes

Study Design. Retrospective database analysis.

Objective. To assess the effect glycemic control has on perioperative morbidity and mortality in patients undergoing elective degenerative lumbar spine surgery.

Summary of Background Data. Diabetes mellitus (DM) is a prevalent disease of glucose dysregulation that has been demonstrated to increase morbidity and mortality after spine surgery. However, there is limited understanding of whether glycemic control influences surgical outcomes in patients with DM undergoing lumbar spine procedures for degenerative conditions.

Methods. The Nationwide Inpatient Sample was analyzed from 2002 to 2011. Hospitalizations were isolated on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery and diagnoses codes for degenerative conditions of the lumbar spine. Patients were then classified into 3 cohorts: controlled diabetic, uncontrolled diabetic, and nondiabetic. Patient demographic data, acute complications, and hospitalization outcomes were determined for each cohort.

Results. A total of 403,629 (15.7%) controlled diabetic patients and 19,421 (0.75%) uncontrolled diabetic patients underwent degenerative lumbar spine surgery from 2002 to 2011. Relative to nondiabetic patients, uncontrolled diabetic patients had significantly increased odds of cardiac complications, deep venous thrombosis, and postoperative shock; in addition, uncontrolled diabetic patients also had an increased mean length of stay (approximately, 2.5 d), greater costs (1.3-fold), and a greater risk of inpatient mortality (odds ratio = 2.6, 95% confidence interval = 1.5–4.8, P < 0.0009). Controlled diabetic patients also had increased risk of acute complications and inpatient mortality when compared with nondiabetic patients, but not nearly to the same magnitude as uncontrolled diabetic patients.

Conclusion. Suboptimal glycemic control in diabetic patients undergoing degenerative lumbar spine surgery leads to increased risk of acute complications and poor outcomes. Patients with uncontrolled DM, or poor glucose control, may benefit from improving glycemic control prior to surgery.

Level of Evidence: 3

Relative to nondiabetic patients, uncontrolled diabetic patients undergoing degenerative lumbar spine surgery have increased risk of perioperative complications and mortality. Poor glycemic control is also associated with extended length of stay and increased costs. Patients with suboptimal glucose control may have better outcomes if improvement of glucose control is realized prior to surgery.

Departments of *Orthopaedic Surgery and

Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.

Address correspondence and reprint requests to Samuel K. Cho, MD, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 5 East 98th St, Box 1188, New York, NY 10029; E-mail: samuel.cho@mountsinai.org

Acknowledgment date: April 10, 2014. Revision date: May 26, 2014. Acceptance date: June 17, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, royalties.

© 2014 by Lippincott Williams & Wilkins