Importance of Hemoglobin A1c Levels for the Detection of Post-Surgical Infection Following Single-Level Lumbar Posterior Fusion in Patients with Diabetes

Abstract

ObjectiveSeveral studies have reported that patients with diabetes mellitus (DM) are vulnerable to infection. However, the mechanism underlying this remains unclear. We hypothesized that preoperative blood glucose levels in patients with DM may be a risk factor for surgical site infection (SSI). We aimed to investigate the relationship between hemoglobin A1c (HbA1c) level and SSI incidence following single-level spinal fusion surgery.MethodsPatients with DM who underwent single-level lumbar posterior fusion surgery were retrospectively reviewed. Ninety-two patients were included and classified into the SSI and SSI-free groups. Clinical data with demographic findings were obtained and compared. The HbA1c cut-off value was defined using receiver operating characteristic (ROC) and area under the curve (AUC) analyses, which showed a significantly increased SSI risk. Potential variables were verified using multiple logistic regression analysis.ResultsAmong the enrolled patients, 24 had SSI and 68 did not within 1 year. The preoperative HbA1c level was higher in patients with SSI (6.8%) than in the non-infected patients (6.0%; p=0.008). ROC analysis showed that if the HbA1c level is higher than 6.9%, the risk of SSI significantly increases (p=0.003; AUC, 0.708; sensitivity, 62.5%; specificity, 70.6%). The preoperative HbA1c level was significantly correlated with SSI incidence, after adjusting for potential variables (p=0.008; odds ratio, 4.500; 95% confidence interval, 1.486–13.624).ConclusionThe HbA1c level, indicating glycemic control, in patients with DM may be a risk factor for SSI in single-level lumbar spine posterior fusion.

Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

“…Of these, 4 studies reported extensive postoperative follow-up of over 1 year; 3 of these studies utilized HbA1c threshold ranging from 6.5-6.9%, and indicated that elevated values above threshold were associated with poor long-term functional outcomes, increased nonunion rate, decreased fusion rate, and increased infection rate following PLF. 28 - 30 The remaining study with 1 year follow-up reached similar conclusions but utilized a higher HbA1c threshold (7.5%). 31 Considering that HbA1c thresholds <7.5% still resulted in adverse postoperative outcomes, using lower values to gauge postoperative risk may be more recommended.…”

“…Four studies reported on the association between elevated HbA1c and adverse postoperative outcomes following PLF. [27][28][29][30] Takashi et al reported that elevated HbA1c was associated with increased VAS scores for low back pain at final follow-up (29.3 vs 17.9, p < 0.013, Table 8). Moazzeni et al reported that VAS scores were significantly different between patients with elevated vs. normal HbA1c for the first 2 weeks postoperatively (5.4 vs 4.4, p ¼ 0.003, Table 8) but reported that VAS scores were no longer significant after 6 months (4.2 vs 3.6, p ¼ 0.08, Table 8).…”

Learning Curve and Complications Experience of Oblique Lateral Interbody Fusion : A Single-Center 143 Consecutive Cases

“…Therefore, cases requiring revision due to infection are relatively rare. In the posterior approach, prolonged CRP normalization occurred in 26.1% (24/92) of the cases and revision for abscess drainage was required in 3.2% (3/92) of the cases [ 13 ]. However, prolonged CRP normalization was found to be low at 4.9% (7/143).…”

“…If CRP rebounded without other infectious causes (e.g., urinary tract infection, pneumonia, etc. ), additional antibiotics were administered until CRP normalization [ 13 , 16 ].…”

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

“…Hwang, J. U. team discovered that hb1c level more than 6.9% would increase the risk of getting SSI [29]. Peng, W. concluded that during 6 years of retrospective study of 523 Diabetes Mellitus patient who went for lumbar surgery, 7.1% got SSI, superficial infection accounted for 4.2% and deep infection made up 2.9% [30].…”