Diabetes Mellitus as a Risk Factor for Acute Postoperative Complications Following Elective Adult Spinal Deformity Surgery

John Di Capua; Nahyr Lugo-Fagundo; Sulaiman Somani; Jun S Kim; Kevin Phan; Nathan J Lee; Parth Kothari; Khushdeep S Vig; Samuel K Cho

doi:10.1177/2192568218761361

Diabetes Mellitus as a Risk Factor for Acute Postoperative Complications Following Elective Adult Spinal Deformity Surgery

Global Spine J. 2018 Sep;8(6):615-621. doi: 10.1177/2192568218761361. Epub 2018 Mar 26.

Authors

John Di Capua¹, Nahyr Lugo-Fagundo², Sulaiman Somani¹, Jun S Kim¹, Kevin Phan^{3

4}, Nathan J Lee¹, Parth Kothari¹, Khushdeep S Vig¹, Samuel K Cho¹

Affiliations

¹ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Ponce Health Sciences University, Ponce, Puerto Rico.
³ University of New South Wales, Sydney, New South Wales, Australia.
⁴ Prince of Wales Private Hospital, Sydney, New South Wales, Australia.

Abstract

Study design: Retrospective cohort study.

Objectives: Diabetes mellitus is a highly prevalent disease in the United States. Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. Considering utilization of spinal surgery will continue to increase, this study investigates the influence of diabetes mellitus on acute postoperative outcomes following elective ASD surgery.

Methods: The 2010-2014 American College of Surgeon's National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases (9th Revision) diagnosis codes relevant to ASD surgery. Patients were divided into cohorts based on their diabetic status. Bivariate and multivariate logistic regression analyses were employed to identify which 30-day postoperative outcomes patients are at risk for.

Results: A total of 5809 patients met the inclusion criteria for the study of which 4553 (84.2%) patients were nondiabetic, 578 (10.7%) patients had non-insulin-dependent diabetes mellitus (NIDDM), and 275 (5.1%) patients had insulin-dependent diabetes mellitus (IDDM). Diabetes status was significantly associated with length of stay ≥5 days (NIDDM: odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.02-1.58, P = .034; IDDM: OR = 1.55, 95% CI = 1.15-2.09, P = .004), any complication (NIDDM: OR = 1.26, 95% CI = 1.01-1.58, P = .037), urinary tract infection (NIDDM: OR = 1.87, 95% CI = 1.14-3.05, P = .012), and cardiac complications (IDDM: OR = 4.05, 95% CI = 1.72-9.51, P = .001).

Conclusions: Given the prevalence of diabetes, surgeons will invariably encounter these patients for ASD surgery. The present study identifies the increased risk NIDDM and IDDM patients experience following ASD surgery. Quantification of this increased risk may improve the selection of appropriate surgical candidates, patient risk stratification, and patient postoperative safety.

Keywords: ACS-NSQIP; ASD; complications; deformity; national database; outcomes; spinal fusion.