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Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery.

ABSTRACT: Retrospective database analysis.To assess the effect glycemic control has on perioperative morbidity and mortality in patients undergoing elective degenerative lumbar spine surgery.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.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.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.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.3.

SUBMITTER: Guzman JZ

PROVIDER: S-EPMC4149698 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery.

Guzman Javier Z JZ Iatridis James C JC Skovrlj Branko B Cutler Holt S HS Hecht Andrew C AC Qureshi Sheeraz A SA Cho Samuel K SK

Spine 20140901 19

<h4>Study design</h4>Retrospective database analysis.<h4>Objective</h4>To assess the effect glycemic control has on perioperative morbidity and mortality in patients undergoing elective degenerative lumbar spine surgery.<h4>Summary of background data</h4>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 ou ...[more]

PMID: 24983935

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Project description:Retrospective administrative database analysis.To determine the impact of glycemic control on perioperative complications and outcomes in patients undergoing degenerative cervical spine surgery.Diabetes mellitus (DM) is a highly prevalent systemic disease that has been shown to increase morbidity and mortality after spine surgery. Few studies have demonstrated negative effects on patients with DM who undergo cervical spine procedures; however, whether glycemic control influences surgical outcome is still unknown.The Nationwide Inpatient Sample was queried from 2002 to 2011. Patients who underwent cervical spine surgery for degenerative conditions were identified using the International Classification of Diseases Ninth Revision, Clinical Modification, codes. Three surgical cohorts were chosen: controlled diabetic, uncontrolled diabetic, and patients without diabetes. Patient demographics, surgical procedures, perioperative complications and postoperative outcomes were assessed.The prevalence of controlled and uncontrolled diabetic patients undergoing degenerative cervical spine surgery had been increasing significantly from 2002 to 2011. Compared with patients without diabetes, uncontrolled diabetic patients had significantly increased odds of respiratory, cardiac, and genitourinary complications. Uncontrolled diabetic patients also had significantly increased risk of pulmonary embolism and postoperative infection. Uncontrolled diabetic patients had increased risk of inpatient mortality (odds ratio = 6.39, 95% confidence interval = 4.09-10.00, P < 0.0001) and increased mean length of stay (almost 5 d) compared with nondiabetic patients. Similarly, controlled diabetic patients increased the odds of perioperative complications; however not nearly to the same degree. Controlled diabetic patients extended the mean length of stay by almost a day (P < 0.0001) and significantly increased costs compared with nondiabetic patients.Poor glycemic control increases the odds of inpatient mortality and perioperative complications in patients undergoing degenerative cervical spine surgery. Controlling DM before degenerative cervical spine surgery may lead to better outcomes and decreased costs.Therapeutic Level 3.

Project description:BackgroundDegenerative spinal diseases are common in older adults with concurrent frailty. Preoperative frailty is a strong predictor of adverse clinical outcomes after surgery. This study aimed to investigate the association between health-related outcomes and frailty in patients undergoing spine surgery for degenerative spine diseases.MethodsA systematic review and meta-analysis were performed by electronically searching Ovid-MEDLINE, Ovid-Embase, Cochrane Library, and CINAHL for eligible studies until July 16, 2022. We reviewed all studies, excluding spinal tumours, non-surgical procedures, and experimental studies that examined the association between preoperative frailty and related outcomes after spine surgery. A total of 1,075 articles were identified in the initial search and were reviewed by two reviewers, independently. Data were subjected to qualitative and quantitative syntheses by meta-analytic methods.ResultsThirty-eight articles on 474,651 patients who underwent degenerative spine surgeries were included and 17 papers were quantitatively synthesized. The health-related outcomes were divided into clinical outcomes and patient-reported outcomes; clinical outcomes were further divided into postoperative complications and supportive management procedures. Compared to the non-frail group, the frail group was significantly associated with a greater risk of high mortality, major complications, acute renal failure, myocardial infarction, non-home discharge, reintubation, and longer length of hospital stay. Regarding patient-reported outcomes, changes in scores between the preoperative and postoperative Oswestry Disability Index scores were not associated with preoperative frailty.ConclusionsIn degenerative spinal diseases, frailty is a strong predictor of adverse clinical outcomes after spine surgery. The relationship between preoperative frailty and patient-reported outcomes is still inconclusive. Further research is needed to consolidate the evidence from patient-reported outcomes.

Project description:Retrospective review of a prospectively collected database.To examine whether short- and long-term outcomes after surgery for lumbar stenosis (SPS) and degenerative spondylolisthesis (DS) vary across centers.Surgery has been shown to be of benefit for both SPS and DS. For both conditions, surgery often consists of laminectomy with or without fusion. Potential differences in outcomes of these overlapping procedures across various surgical centers have not yet been investigated.Spine Patient Outcomes Research Trial cohort participants with a confirmed diagnosis of SPS or DS undergoing surgery were followed from baseline at 6 weeks, 3, 6, and 12 months, and yearly thereafter, at 13 spine clinics in 11 US states. Baseline characteristics and short- and long-term outcomes were analyzed.A total of 793 patients underwent surgery. Significant differences were found between centers with regard to patient race, body mass index, treatment preference, neurological deficit, stenosis location, severity, and number of stenotic levels. Significant differences were also found in operative duration and blood loss, the incidence of durotomy, the length of hospital stay, and wound infection. When baseline differences were adjusted for, significant differences were still seen between centers in changes in patient functional outcome (Short Form-36 bodily pain and physical function, and Oswestry Disability Index) at 1 year after surgery. In addition, the cumulative adjusted change in the Oswestry Disability Index Score at 4 years significantly differed among centers, with Short Form-36 scores trending toward significance.There is a broad and statistically significant variation in short- and long-term outcomes after surgery for SPS and DS across various academic centers, when statistically significant baseline differences are adjusted for. The findings suggest that the choice of center affects outcome after these procedures, although further studies are required to investigate which center characteristics are most important.

Project description:BackgroundCurrent guidelines for the management of patients with specific low back pain pathology suggest non-surgical intervention as first-line treatment, but there is insufficient evidence to make recommendations of the content in the non-surgical intervention. Opinions regarding the dose of non-surgical intervention that should be trialled prior to decision making about surgery intervention vary. The aim of the present study is to investigate if physiotherapy administrated before surgery improves function, pain and health in patients with degenerative lumbar spine disorder scheduled for surgery. The patients are followed over two years. A secondary aim is to study what factors predict short and long term outcomes.MethodsThis study is a single blinded, 2-arm, randomized controlled trial with follow-up after the completion of pre-surgery intervention as well as 3, 12 and 24 months post-surgery. The study will recruit men and women, 25 to 80 years of age, scheduled for surgery due to; disc herniation, spinal stenosis, spondylolisthesis or degenerative disc disease. A total of 202 patients will be randomly allocated to a pre-surgery physiotherapy intervention or a waiting list group for 9 weeks. The waiting-list group will receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. The pre-surgery physiotherapy group will receive physiotherapy 2 times per week, consisting of a stratified classification treatment, based on assessment findings. One of the following treatments will be selected; a) Specific exercises and mobilization, b) Motor control exercises or c) Traction. The pre-surgery physiotherapy group will also be prescribed a tailor-made general supervised exercise program. The physiotherapist will use a behavioral approach aimed at reducing patient fear avoidance and increasing activity levels. They will also receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. Primary outcome measure is Oswestry Disability Index. Secondary outcome measures are the visual analogue scale for back and leg pain, pain drawing, health related quality of life, Hospital anxiety and depression scale, Fear avoidance beliefs questionnaire, Self-efficacy scale and Work Ability Index.DiscussionThe study findings will help improve the treatment of patients with degenerative lumbar spine disorder scheduled for surgery.Trial registrationClinicalTrials.gov reference: NCT02454400 (Trial registration date: August 31st 2015) and has been registered on ClinicalTrials.gov, identifier: NCT02454400 .

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Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery.

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Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery.

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