Diabetes and Early Postoperative Outcomes Following Lumbar Fusion

Abstract

This nationally representative study of inpatients in the United States provides evidence that diabetes is associated with increased risk for postoperative complications, nonroutine discharge, increased total hospital charges, and length of stay following lumbar fusion. Prospective studies to determine causality as well as the potential impact of diabetes control on these variables have not yet been done.

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

“…Second, any research using the NIS database cannot assess traditionally supported and validated outcome measures such as 30-day and 1-year mortality, pain scores, and outcome questionnaires (SF-36, Oswestry Disability Index, and others). This disadvantage has been surmounted by using previously described surrogate measures of functional outcome including in-hospital complications [3,5,10,11,33,52,53], in-hospital mortality [1,3,10,33,53], and patient disposition at hospital discharge [10,11,33,52,53]. Third, evidence is mounting to suggest patients who undergo kyphoplasty experience up to 36% higher risk of subsequent VCF resulting from the increased biomechanical stiffness of the treated vertebral body [22,29,45].…”

“…Other studies using the NIS database have considered the occurrence of in-hospital complications and mortality as a measure of the immediate and early outcome of a surgical intervention [1,3,5,10,17,18,33,36,52] or of the impact of a comorbidity or complication on outcome [11,53]. The lower rate of in-hospital mortality in patients treated with kyphoplasty suggests that, in our patient sample, kyphoplasty affects the restoration of independent functional mobility in a manner that leads to a lower likelihood of developing a life-threatening complication of treatment.…”

“…As discussed, patients who undergo kyphoplasty appear to have a higher likelihood of avoiding the use of these posthospital inpatient facilities. Other authors have used the discharge status of a patient as a measure of the use of posthospital discharge resources [3,10,11,52]. A routine discharge to home can be assumed to use fewer medical resources than an admission to another facility and therefore decrease the overall cost of care for the VCF.…”

“…This database has been used to evaluate use trends and outcomes for a variety of procedures in spine surgery [1,5,10,15,20,26,28,33,36,47,52,59] as well as the impact of comorbidities on the outcome of spine procedures [3,11,17,18]. Such a database allows a larger patient sample to be amassed in relatively short period of time and for a lower cost than could be achieved by even a large multicenter trial; they also can offer insight into the actual use, complications, and outcomes of a procedure in ''real life'' and without the restrictive criteria imposed for inclusion in controlled trials.…”

Using the Spine Surgical Invasiveness Index to Identify Risk of Surgical Site Infection

“…S urgical site infection after spine surgery is an uncommon but well-known complication that can result in a poor outcome, arthrodesis-site nonunion, and neurological injury [1][2][3][4][5][6][7] . In the setting of a surgical site infection, patients are likely to require intravenous (IV) antibiotics, a prolonged hospital stay 8 , and operative debridement.…”