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  • Anterior Cervical Discectomy and Fusion: The Impact of Diabetes Mellitus on In-Hospital Complication Rates and Cost of Care

    Final Number:

    William Shuman; Sean N Neifert BS; Daniel J Snyder BS; Brian C. Deutsch BS; Jonathan S. Gal MD; Jeffrey H Zimering MD; Robert J. Rothrock MD; John M. Caridi MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit 2019

    Introduction: Anterior cervical discectomy and fusion (ACDF) is commonly used to treat degenerative disc disease and is associated with good outcomes and low complication rates. Diabetes mellitus (DM) is one of the most common comorbidities for patients undergoing ACDF, but the literature is equivocal about the impact it has on outcomes. As DM becomes increasingly prevalent, it is crucial to determine if it is a predictive risk factor for episode-based outcomes after ACDF procedures.

    Methods: Patients at a single institution from 2006-2016 undergoing ACDF were compared on the basis of having a prior diagnosis of DM vs. no DM. The two cohorts were compared utilizing chi-square, Student's t-test, and multivariate logistic and linear regression.

    Results: Data for 2,390 patients undergoing ACDF at a single institution from 2008 to 2016 was analyzed retrospectively. Patients with DM had a significantly higher proportion of American Society of Anesthesiologists (ASA) designations greater than two (62.0% vs. 22.6%, p<0.0001) and Elixhauser Comorbidity Index levels greater than five (12.0% vs. 3.9%, p<0.0001). Diabetic patients were more likely suffer from sepsis (0.6% vs. 0.1%, p=0.04). All other complication rates were similar between the two groups. In multivariate analyses adjusting for age, sex, ASA status, and Elixhauser Comorbidity index score, diabetic patients had similar in-hospital complication rates to those without diabetes. The direct cost of care was shown to be similar between the two groups after adjusting for patient, surgical, and hospital-related factors (-$444.12, 95% CI -$957.79 to $69.55).

    Conclusions: Patients with DM undergoing ACDF have similar outcomes and cost of care compared to non-diabetic patients.

    Patient Care: The results of the present study will inform physicians on how to better design a treatment plan for patients with diabetes presenting with cervical disc diseases.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the predictive value of diabetes on the outcomes of patients undergoing ACDF, 2) List the demographic and surgical factors that can be used to determine a patient's overall health and hospital course, and 3) Describe the effect Diabetes has on cost of care for patients undergoing ACDF.

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