Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Clin Spine Surg. 2020 Aug;33(7):E307-E311. doi: 10.1097/BSD.0000000000001012.
Retrospective cohort.
To determine if the presence of diabetes mellitus as comorbidity is associated with complications, inpatient length of stay, or direct hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Very few studies have investigated the effect of diabetes on complications, length of stay, or costs in minimally invasive lumbar surgeries.
Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed. Diabetic and nondiabetic patients were propensity matched in a 1:1 manner for age, sex, and comorbidity burden. An association between diabetic status and preoperative demographic or perioperative variables, including inpatient length of stay, was tested for using Student t test or χ analysis. Multivariate linear regression was used to test for an association between diabetic status and direct hospital costs.
After 1:1 propensity matching, 100 patients were included in this analysis. There were no significant differences in age, sex, body mass index, smoking status, or Charlson Comorbidity Index between propensity-matched patients with and without diabetes. In regards to the length of stay, no significant differences existed between diabetic and nondiabetic groups (68.7 vs. 58.3 h, P=0.218). No other significant differences existed in other perioperative variables including operative time, intraoperative blood loss, or complication rate (P≥0.05 for each). Multivariate analysis indicated that diabetic status was not associated with differences in total direct hospital costs (US$20,428 vs. US$20,429, P=0.792) or cost subcategories after MIS TLIF (P≥0.05 for each).
In this investigation, diabetes was not associated with postoperative complication rates, inpatient length of stay, or direct hospital costs after primary, single-level MIS TLIF. The reduced extent of operative exposure and tissue trauma in MIS TLIF may mitigate the risk of complications in diabetic patients, possibly preventing extensions in hospital stay length and associated hospital costs.
回顾性队列研究。
确定合并糖尿病作为合并症是否与微创经椎间孔腰椎体间融合术（MIS TLIF）后并发症、住院时间或直接住院费用相关。
很少有研究调查糖尿病对微创腰椎手术并发症、住院时间或费用的影响。
对接受初次单节段 MIS TLIF 的患者进行回顾性分析。糖尿病和非糖尿病患者按年龄、性别和合并症负担进行 1:1 倾向匹配。使用 Student t 检验或 χ2 分析检验糖尿病状态与术前人口统计学或围手术期变量（包括住院时间）之间的关联。使用多元线性回归检验糖尿病状态与直接住院费用之间的关联。
在 1:1 倾向匹配后，共有 100 例患者纳入本分析。在糖尿病和非糖尿病患者中，年龄、性别、体重指数、吸烟状况或 Charlson 合并症指数无显著差异。在住院时间方面，糖尿病组和非糖尿病组之间无显著差异（68.7 小时与 58.3 小时，P=0.218）。其他围手术期变量（包括手术时间、术中失血量和并发症发生率）也无显著差异（P≥0.05）。多因素分析表明，糖尿病状态与 MIS TLIF 后总直接住院费用（20428 美元与 20429 美元，P=0.792）或成本分类（每项 P≥0.05）无差异。
在本研究中，糖尿病与初次单节段 MIS TLIF 后术后并发症发生率、住院时间或直接住院费用无关。MIS TLIF 中手术暴露和组织创伤程度的降低可能降低了糖尿病患者发生并发症的风险，从而可能缩短住院时间和相关住院费用。
