Phan Kevin, Kim Jun S, Lee Nathan, Kothari Parth, Cho Samuel K
NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
Spine (Phila Pa 1976). 2017 Apr 1;42(7):456-464. doi: 10.1097/BRS.0000000000001829.
A retrospective analysis of prospectively collected data.
Our objective was to analyze insulin-dependent and noninsulin-dependent diabetes mellitus (IDDM and NIDDM) as potential risk factors for complications, reoperations, and readmissions within 30 days following anterior cervical discectomy and fusion (ACDF).
ACDF is a common surgical procedure with growing utilization and good long-term outcomes. Readmissions and reoperations are associated with increased morbidity and inferior long-term outcomes. IDDM and NIDDM are often associated with increased complication rates.
This was a retrospective analysis of prospectively collected data from the ACS NSQIP database. Patients ≥18 years old undergoing ACDF from 2005 to 2012 were included. Readmission, perioperative events, and reoperation within 30 days following ACDF were measured. Patient demographics, perioperative data, preoperative labs, and postoperative events were assessed. Patients with NIDDM or IDDM were compared with nondiabetic patients using multivariate logistic regression analysis with significance defined as P < 0.05. Odds ratio (OR) was calculated with a 95% confidence interval (CI).
Three thousand seven hundred twenty-six patients were included of whom 270 were NIDDM and 171 IDDM. Readmissions and reoperation data were available only from 2011 to 2012, including 1423 nondiabetes mellitus (non-DM), 193 NIDDM, and 87 IDDM cases. NIDDM was associated with higher rates of urinary tract infection (UTI) (P < 0.007), and return to operating room (P = 0.012) than nondiabetic patients. IDDM was associated with higher rates of reoperations (P = 0.04), readmissions (P < 0.0001), and total length of stay (LOS) >5 days (P < 0.0001). Following adjusted multivariate analysis, only IDDM status remained an independent predictor for 30-day readmission (OR 4.8, 95% CI 2.3-10.1).
Patients with NIDDM and IDDM were at an increased risk for several postoperative complications following ACDF. IDDM was independently associated with increased 30-day readmission rates. Diabetic patients should be counseled appropriately, and the importance of close perioperative care is highlighted in this study.
对前瞻性收集的数据进行回顾性分析。
我们的目的是分析胰岛素依赖型和非胰岛素依赖型糖尿病（IDDM和NIDDM）作为颈椎前路椎间盘切除融合术（ACDF）后30天内并发症、再次手术和再入院的潜在风险因素。
ACDF是一种常见的外科手术，其应用日益广泛且长期效果良好。再入院和再次手术与发病率增加及长期效果较差相关。IDDM和NIDDM通常与并发症发生率增加有关。
这是一项对从美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库中前瞻性收集的数据进行的回顾性分析。纳入了2005年至2012年接受ACDF的18岁及以上患者。测量了ACDF后30天内的再入院、围手术期事件和再次手术情况。评估了患者的人口统计学特征、围手术期数据、术前实验室检查结果和术后事件。使用多因素逻辑回归分析将NIDDM或IDDM患者与非糖尿病患者进行比较，显著性定义为P<0.05。计算比值比（OR）并给出95%置信区间（CI）。
共纳入3726例患者，其中270例为NIDDM，171例为IDDM。再入院和再次手术数据仅可得自2011年至2012年，包括1423例非糖尿病（non-DM）、193例NIDDM和87例IDDM病例。与非糖尿病患者相比，NIDDM与更高的尿路感染（UTI）发生率（P<0.007）和返回手术室的发生率（P = 0.012）相关。IDDM与更高的再次手术发生率（P = 0.04）、再入院发生率（P<0.0001）和住院总时长>5天的发生率（P<0.0001）相关。经过校正的多因素分析后，仅IDDM状态仍然是30天再入院的独立预测因素（OR 4.8，95% CI 2.3 - 10.1）。
NIDDM和IDDM患者在ACDF后发生几种术后并发症的风险增加。IDDM与30天再入院率增加独立相关。应适当地向糖尿病患者提供咨询，本研究强调了围手术期密切护理的重要性。
3级。
