Golinvaux Nicholas S, Varthi Arya G, Bohl Daniel D, Basques Bryce A, Grauer Jonathan N
From the Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT.
Spine (Phila Pa 1976). 2014 Oct 1;39(21):1809-16. doi: 10.1097/BRS.0000000000000506.
Retrospective cohort.
To determine the effect of non-insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM) on postoperative complications after elective lumbar fusion surgery.
Diabetes mellitus (DM) is a common chronic disease. The effects of NIDDM and IDDM on rates of postoperative complications, extended length of stay, and readmission after lumbar fusion surgery are not well established.
A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients undergoing lumbar fusion between 2005 and 2012 were identified and characterized as having NIDDM, IDDM, or neither. Bivariate and multivariate analyses were used to test patients with NIDDM and IDDM for increased risk of adverse postoperative outcomes over the initial 30 postoperative days.
A total of 15,480 patients who underwent lumbar fusion were identified (13,043 were patients without DM, 1,650 patients had NIDDM, and 787 patients had IDDM).NIDDM was independently associated with an increased risk of wound dehiscence (relative risk = 2.3; P = 0.033) and extended length of stay (1.2; P < 0.003).IDDM was independently associated with an increased risk of death (2.7; P = 0.020), sepsis (2.2; P = 0.002), septic shock (3.3; P = 0.032), unplanned intubation (2.8; P = 0.003), ventilator-assisted respiration for more than 48 hours postoperatively (2.8; P = 0.005), wound-related infection (1.9; P = 0.001), urinary tract infection (1.6; P = 0.011), pneumonia (3.1; P < 0.001), extended length of stay (1.5; P < 0.001), and readmission within 30 days (1.5; P = 0.036).
Compared with patients without DM, IDDM was associated with an increased risk of a considerably higher number of postoperative complications than NIDDM. These complications were also of greater severity. This important designation may improve preoperative risk stratification and counseling of patients with diabetes prior to lumbar fusion surgery.
回顾性队列研究。
确定非胰岛素依赖型糖尿病（NIDDM）和胰岛素依赖型糖尿病（IDDM）对择期腰椎融合手术后并发症的影响。
糖尿病（DM）是一种常见的慢性病。NIDDM和IDDM对腰椎融合手术后并发症发生率、住院时间延长及再入院率的影响尚未完全明确。
使用美国外科医师学会国家外科质量改进计划数据库进行回顾性队列研究。确定2005年至2012年间接受腰椎融合手术的患者，并将其分为患有NIDDM、IDDM或两者皆无。采用双变量和多变量分析来检测NIDDM和IDDM患者在术后最初30天内出现不良术后结局的风险是否增加。
共确定15480例接受腰椎融合手术的患者（13043例无糖尿病患者，1650例患有NIDDM，787例患有IDDM）。NIDDM与伤口裂开风险增加独立相关（相对风险=2.3；P=0.033）以及住院时间延长（1.2；P<0.003）。IDDM与死亡风险增加独立相关（2.7；P=0.020）、脓毒症（2.2；P=0.002）、感染性休克（3.3；P=0.032）、非计划插管（2.8；P=0.003）、术后呼吸机辅助呼吸超过48小时（2.8；P=0.005）、伤口相关感染（1.9；P=0.001）、尿路感染（1.6；P=0.011）、肺炎（3.1；P<0.001）、住院时间延长（1.5；P<0.001）以及30天内再入院（1.5；P=0.036）。
与无糖尿病患者相比，IDDM患者术后并发症数量显著多于NIDDM患者，且并发症严重程度更高。这一重要结论可能有助于改善腰椎融合手术前糖尿病患者的术前风险分层和咨询。
3级。
