Diabetes Is Predictive of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion

Abstract

Study Design: Retrospective cohort study. Objective: The present study analyzes complication rates and episode-based costs for patients with and without diabetes mellitus (DM) following posterior lumbar fusion (PLF). Methods: PLF cases at a single institution from 2008 to 2016 were queried (n = 3226), and demographic and perioperative data were analyzed. Patients with and without the diagnosis of DM were compared using chi-square, Student’s t test, and multivariable regression modeling. Results: Patients with diabetes were older (63.10 vs 56.48 years, P < .001) and possessed a greater number of preoperative comorbidities (47.84% of patients had Elixhauser Comorbidity Index >0 vs 42.24%, P < .001) than did patients without diabetes. When controlling for preexisting differences, diabetes remained a significant risk factor for prolonged length of stay (OR = 1.59, 95% CI 1.26-2.01, P < .001), intensive care unit stay (OR = 1.52, 95% CI 1.07-2.17, P = .021), nonhome discharge (OR = 1.86, 95% CI 1.46-2.37, P < .001), 30-day readmission (OR = 2.15, 95% CI 1.28-3.60, P = .004), 90-day readmission (OR = 1.65, 95% CI 1.05-2.59, P = .031), 30-day emergency room visit (OR = 2.15, 95% CI 1.27-3.63, P = .004), and 90-day emergency room visit (OR = 2.27, 95% CI 1.41-3.65, P < .001). Cost modeling controlling for overall comorbidity burden demonstrated that diabetes was associated with a $1709 increase in PLF costs (CI $344-$3074, P = .014). Conclusions: The present findings indicate a correlation between diabetes and a multitude of postoperative adverse outcomes and increased costs, thus illustrating the substantial medical and financial burdens of diabetes for PLF patients. Future studies should explore preventive measures that may mitigate these downstream effects.

Risk Factors for 30-day Unplanned Readmission following Surgery for Lumbar Degenerative Diseases: A Systematic Review

“…Of these, 26 7 , 13 - 18 , 20 - 22 , 24 , 25 , 27 , 28 , 33 - 40 , 42 - 45 were retrospective cohort studies, 1 23 was a prospective cohort study and 9 8 , 9 , 19 , 26 , 29 - 32 , 41 were case-control studies. Among them, 20 7 , 9 , 15 - 17 , 23 , 25 , 26 , 29 , 32 - 36 , 38 - 40 , 42 , 44 , 45 included patients from the NSQIP database, 2 from State Inpatient Databases (SID) 13 , 28 , 3 from Nationwide Readmissions Database (NRD) 8 , 18 , 41 , 4 from the Medicare database 20 , 24 , 37 , 43 , 2 from the Quality Outcomes Database (QOD) 21 , 22 , and 3 from institutional database ...…”

“…A total of 23 studies 7 - 9 , 14 , 15 , 19 , 20 , 23 , 26 , 28 - 33 , 35 , 38 - 43 , 45 were defined as having a moderate risk of bias and 13 13 , 16 - 18 , 21 , 22 , 24 , 25 , 27 , 34 , 36 , 37 , 44 were deemed to have a high risk of bias.…”

“…Among these studies, 5 reported a history of chronic obstructive pulmonary disease (COPD) 7 , 9 , 26 , 35 , 42 associated with readmission. Eleven studies 7 , 8 , 14 , 28 - 32 , 38 , 41 , 42 reported diabetes mellitus (DM) as a potential risk factor, 9 7 , 8 , 14 , 28 , 30 , 32 , 38 , 41 , 42 of which showed statistically significant results in this regard. Three studies 7 , 28 , 42 reported heart failure and 2 of them 28 , 42 found that patients with heart failure had a higher risk of readmission.…”

Minimally Invasive vs. Open Surgery for Lumbar Spinal Stenosis in Patients with Diabetes – A Canadian Spine Outcomes and Research Network Study

“…Diabetes is associated with worse outcomes following spine surgery. [8][9][10][11][12] Moreover, diabetes has been shown to be a risk factor for the development of LSS. [5][6][7] As a result, maximizing the surgical benefits for patients with diabetes is of particular importance.…”

“…1,4 Diabetes has been shown to be a risk factor for development of LSS and is correlated with more adverse events (AEs) and worse outcomes following spine surgery. [5][6][7][8][9][10][11][12] It is postulated that because of comorbidities, micro-/macro-vascular degeneration, and impaired tissue healing, patients with diabetes have worse outcomes following spinal surgery. [9][10][11][12] This makes the outcomes of patients with diabetes undergoing surgery for LSS of particular importance.…”