Kim Chi Heon, Chung Chun Kee, Shin Sukyoun, Choi Bo Ram, Kim Min Jung, Park Byung Joo, Choi Yunhee
Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea; Neuroscience and Clinical Research Institute, Seoul National University Hospital, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea.
Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea; Neuroscience and Clinical Research Institute, Seoul National University Hospital, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea.
Spine J. 2015 May 1;15(5):866-74. doi: 10.1016/j.spinee.2015.01.029. Epub 2015 Jan 29.
Diabetes is present in 5% to 20% of patients undergoing spine surgeries and is a known risk factor for reoperation. Considering the chronicity of diabetes, its influence on the reoperation rate may differ over time.
To present the relationship between diabetes and the reoperation rate over time.
STUDY DESIGN/SETTING: Retrospective cohort study.
A national health insurance database was used to identify a cohort of patients who underwent an initial surgery for lumbar degenerative disease in 2003 (n=34,918).
The primary end point was any type of second lumbar surgery after fusion surgery (n=4,792) or decompression surgery (n=30,126) during the early (0-postoperative 90 days), short-term (91-365 days), and midterm (1-6 years) periods.
All patients were followed up until December 2008. Cox proportional hazards regression modeling was used to assess the adjusted reoperation rates in the diabetic patients.
The incidence of diabetes in the present cohort was 24.5% in the fusion group and 16.9% in the decompression group. Overall, reoperation was performed in 13.2% (631 of 4,792) of the patients after fusion surgery and in 14.0% (4,214 of 30,126) of the patients after decompression surgery. After fusion surgery, diabetes did not make a significant difference in the reoperation rate during the entire follow-up period. After decompression surgery, the reoperation rate was not different during Postoperative Month 3, but diabetic patients showed a 1.2 to 1.4 times higher reoperation rate during postoperative 3 months to 5 years (p<.01).
The study did not find a relationship between diabetes at the time of surgery and the reoperation rate during the early postoperative period. Thereafter, the reoperation rate was not higher after fusion surgery in diabetic patients, but it was higher after decompression surgery.
接受脊柱手术的患者中，5%至20%患有糖尿病，且糖尿病是再次手术的已知风险因素。考虑到糖尿病的慢性病程，其对再次手术率的影响可能随时间而有所不同。
阐述糖尿病与随时间变化的再次手术率之间的关系。
研究设计/地点：回顾性队列研究。
使用国家健康保险数据库确定了一组在2003年接受初次腰椎退行性疾病手术的患者（n = 34,918）。
主要终点是融合手术（n = 4,792）或减压手术（n = 30,126）后，在早期（术后0至90天）、短期（91至365天）和中期（1至6年）期间进行的任何类型的二次腰椎手术。
对所有患者随访至2008年12月。采用Cox比例风险回归模型评估糖尿病患者的调整后再次手术率。
本队列中，融合组糖尿病发病率为24.5%，减压组为16.9%。总体而言，融合手术后13.2%（4,792例中的631例）的患者进行了再次手术，减压手术后14.0%（30,126例中的4,214例）的患者进行了再次手术。融合手术后，糖尿病在整个随访期间对再次手术率没有显著影响。减压手术后，术后第3个月再次手术率无差异，但糖尿病患者在术后3个月至5年的再次手术率高出1.2至1.4倍（p <.01）。
该研究未发现手术时糖尿病与术后早期再次手术率之间的关系。此后，糖尿病患者融合手术后再次手术率并未升高，但减压手术后再次手术率较高。
