Introduction: 8.1 million cases of undiagnosed DM were reported in 2012 by Centers for Disease Control and Prevention. The relationship between hemoglobinA1c (HbA1c) and surgical outcome had been studied in different surgeries. However, it has not enough conducted outcome study with spinal surgery. To improve patient outcomes in spine surgery, the importance of identifying ideal pre operative HbA1c would be variable. The HbA1c does not require fasting prior to lab draw, and the result reflects eight to 12 weeks of prior glycemia. We aim to establish a target HbA1c guideline for ultimate preoperative control of patients with diabetes mellitus undergoing spinal surgery.
Methods: A retrospective cohort study was conducted to evaluate the association between preoperative HbA1c levels and adverse events in spinal surgery at the University of Missouri Health Care Neurosurgery from July 2016 to June 2017. HbA1c levels are widely accepted for the diagnostic tool which is categorized as follows: normal (< 5.7%), prediabetes (5.7% -6.4%)and diabetes (>6.4%). Perioperative complications were defined as the following: stroke, MI, death, UTI, DVT, PE, wound infection, nonunion, failure of hardware, and cerebral spinal fluid leak.
Results: A total of 175 patients were reviewed. The HbA1c level were normal, pre-diabetic, and diabetic were 80, 63 and 32. Perioperative complications were occurred 11/80(13.75%), 14/63(22.2%) and 10/32(31.25%).
The attributable risk in pre-diabetic patients compared to non-diabetic patients was 8.47%, and the relative risk was 1.6. The attributable risk in diabetic patients compared to non-diabetic patients was 17.5%, and the relative risk was 2.27.
Conclusions: Pre-diabetes exposure increased the incidence of perioperative complications by 8.47%, and pre-diabetic patients were 1.6 times more likely to develop perioperative complications than non-diabetic patients. Diabetes exposure increased the incidence of perioperative complications by 17.5%, and diabetic patients were 2.27 times more likely to develop perioperative complications than non-diabetic patients.
Patient Care: Goal is implementing preoperative hyperglycemic control to improve spine surgery outcome.
Learning Objectives: To learn importance of preoperative diagnosis of diabetes and emphasize preoperative hyperglycemia control.
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2. Kotagal, Meera et al. “Perioperative Hyperglycemia and Risk of Adverse Events Among Patients With and Without Diabetes.” Annals of surgery 261.1 (2015): 97–103.
3. Kwon, Steve et al. “Importance of Perioperative Glycemic Control in General Surgery: A Report From the Surgical Care and Outcomes Assessment Program.” Annals of surgery 257.1 (2013): 8–14.
4. Wukich, Dane K. “Diabetes and Its Negative Impact on Outcomes in Orthopaedic Surgery.” World Journal of Orthopedics 6.3 (2015): 331–339.