Characteristics of Diabetes Associated With Poor Improvements in Clinical Outcomes After Lumbar Spine Surgery

Takahashi, Shinji; Suzuki, Akinobu; Toyoda, Hiromitsu; Terai, Hidetomi; Dohzono, Sho; Yamada, Kentarou; Matsumoto, Tomiya; Yasuda, Hiroyuki; Tsukiyama, Kuniaki; Shinohara, Yoshikazu; Ibrahim, Mohammad; Nakamura, Hiroaki

doi:10.1097/brs.0b013e318273583a

Cited by 85 publications

(67 citation statements)

References 22 publications

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“…21,24 19 All of the studies were retrospective (longitudinal) cohorts and retrieved multiinstitutional data from time periods ranging from 1987 to 2012. 8,19,21,24,30 The total patient population in each study varied from 2320 to 35,152. The methods of patient selection differed throughout the studies.…”

Section: Resultsmentioning

confidence: 99%

“…21,24,30 This conclusion is not at all surprising, as studies usually have shown a significant association between diabetes or hypertension and poor postoperative improvement for various procedures. 3,4,7,15,25,35 Diabetes and other comorbid conditions have also been noted as causes of a prolonged in-hospital stay, 4 explaining why Jansson et al 19 and Pugely et al 30 found extended LOS to be predictive of worse outcome.…”

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confidence: 99%

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Causes of 30-day readmission after neurosurgery of the spine

Cusimano

Pshonyak

Lee

et al. 2016

SPI

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OBJECT Thirty-day readmission has been cited as an important indicator of the quality of care in several fields of medicine. The aim of this systematic review was to examine rate of readmission and factors relevant to readmission after neurosurgery of the spine. METHODS The authors carried out a systematic review using several databases, searches of cited reference lists, and a manual search of the JNS Publishing Group journals (Journal of Neurosurgery; Journal of Neurosurgery: Spine; Journal of Neurosurgery: Pediatrics; and Neurosurgical Focus), Neurosurgery, Acta Neurochirurgica, and Canadian Journal of Neurological Sciences. A quality review was performed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS A systematic review of 1136 records published between 1947 and 2014 revealed 31 potentially eligible studies, and 5 studies met inclusion criteria for content and quality. Readmission rates varied from 2.54% to 14.7%. Sequelae that could be traced back to complications that arose during neurosurgery of the spine were a prime reason for readmission after discharge. Increasing age, poor physical status, and comorbid illnesses were also important risk factors for 30-day readmission. CONCLUSIONS Readmission rates have predictable factors that can be addressed. Strategies to reduce readmission that relate to patient-centered factors, complication avoidance during neurosurgery, standardization with system-wide protocols, and moving toward a culture of nonpunitive system-wide error and “near miss” investigations and quality improvement are discussed.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Causes of 30-day readmission after neurosurgery of the spine

Cusimano

Pshonyak

Lee

et al. 2016

SPI

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“…Overweight and obese conditions are risk factors for LBP [2,3]; moreover, diabetes is hypothesized to contribute independently. For example, type 2 diabetes (T2D) appears to increase the frequency and severity of pain [4][5][6][7] and is associated with poor treatment outcomes [8,9]. Since LBP is often related to intervertebral disc degeneration [10], identifying the mechanisms by which T2D affects disc composition and biomechanical behavior is an important step towards improving the management of LBP in diabetes.…”

Section: Introductionmentioning

confidence: 99%

Alterations in Intervertebral Disc Composition, Matrix Homeostasis and Biomechanical Behavior in the UCD-T2DM Rat Model of Type 2 Diabetes

et al. 2015

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Type 2 diabetes (T2D) adversely affects many tissues, and the greater incidence of discogenic low back pain among diabetic patients suggests that the intervertebral disc is affected too. Using a rat model of polygenic obese T2D, we demonstrate that diabetes compromises several aspects of disc composition, matrix homeostasis and biomechanical behavior. Coccygeal motion segments were harvested from 6-month-old lean Sprague-Dawley rats, obese Sprague-Dawley rats, and diabetic obese UCD-T2DM rats (diabetic for 69 ± 7 days). Findings indicated that diabetes but not obesity reduced disc glycosaminoglycan and water contents, and these degenerative changes correlated with increased vertebral endplate thickness and decreased endplate porosity, and with higher levels of the advanced glycation end-product (AGE) pentosidine. Consistent with their diminished glycosaminoglycan and water contents and their higher AGE levels, discs from diabetic rats were stiffer and exhibited less creep when compressed. At the matrix level, elevated expression of hypoxia-inducible genes and catabolic markers in the discs from diabetic rats coincided with increased oxidative stress and greater interactions between AGEs and one of their receptors (RAGE). Taken together, these findings indicate that endplate sclerosis, increased oxidative stress and AGE/RAGE-mediated interactions could be important factors for explaining the greater incidence of disc pathology in T2D.

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“…Diabetes has been reported to have negative impact on the prognosis of spine surgery, including prolonged length of stay, increased hospitalization costs, increased morbidity and mortality, and higher risk of surgical site infection [33][34][35] . There have been several studies showing the influences of diabetic neuropathy and/or angiopathy on the outcomes of lumbar spine surgery [13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

The Impact of Diabetes Mellitus on Patients Undergoing Cervical Spondylotic Myelopathy: A Meta-Analysis

Liu

Ban²,

Kan³

et al. 2016

Eur Neurol

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Aims: We conducted a meta-analysis of eligible studies to compare the surgical outcomes between diabetic patients and non-diabetic patients who have undergone cervical spondylotic myelopathy (CSM). Methods: A systematic literature search of PubMed, Embase, and Web of Science (up to February 10, 2016) was conducted. Eligible studies were case-control or cohort studies that compared the outcomes of cervical surgery between diabetic patients and non-diabetic patients. Weighted mean differences, risk ratios, and 95% CIs were calculated and heterogeneity was assessed with Cochrane Q chi-square test and I² statistic. Results: Six studies with a total of 38,680 patients were included in this meta-analysis. Pooled estimates showed that diabetic patients had significantly lower Japanese Orthopaedic Association (JOA) score change between pre- and post operation, and recovery rate than patients without diabetes. Moreover, diabetic patients had significantly increased risk of operative wound, epidural/wound hematoma, chronic lung disease, and cardiac complication. Other postoperative complications, including cerebrospinal fluid leakage and C5 radiculopathy, were not significantly different between the 2 groups. Conclusion: Diabetes mellitus decreased the JOA score change and recovery rate, as well as increased the risk of postoperative complications in patients undergoing CSM. Controlling diabetes mellitus before cervical spine surgery may lead to better outcomes.

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Characteristics of Diabetes Associated With Poor Improvements in Clinical Outcomes After Lumbar Spine Surgery

Abstract: Longstanding diabetes, poor glycemic control, and insulin use might be associated with poor postoperative improvement.

Cited by 85 publications

References 22 publications

Causes of 30-day readmission after neurosurgery of the spine

Causes of 30-day readmission after neurosurgery of the spine

Alterations in Intervertebral Disc Composition, Matrix Homeostasis and Biomechanical Behavior in the UCD-T2DM Rat Model of Type 2 Diabetes

The Impact of Diabetes Mellitus on Patients Undergoing Cervical Spondylotic Myelopathy: A Meta-Analysis

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