Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, Arkansas, USA; Division of Pediatric Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA; Division of Neurosurgery, University of Missouri School of Medicine, Columbia, Missouri, USA.
Department of Internal Medicine, Alameda Health System, Oakland, California, USA; Medical School, University of Missouri School of Medicine, Columbia, Missouri, USA.
World Neurosurg. 2021 Nov;155:e770-e777. doi: 10.1016/j.wneu.2021.08.133. Epub 2021 Sep 11.
Diabetes mellitus (DM) is associated with a greater incidence of perioperative complications. The measurement of hemoglobin A1c (HbA1c) has not been routinely used in the preoperative assessment for spine surgeries.
In the present single-institution, prospective study, HbA1c testing was included in the preoperative laboratory examination of patients undergoing spinal surgery from 2016 through 2018. The HbA1c levels were categorized using the American Diabetes Association guidelines as normal (HbA1c <5.7%), pre-DM (HbA1c 5.7%-6.4%), and diabetes (HbA1c >6.5%). Those with a HbA1c of ≥8% were separated as having poorly controlled DM for analysis. Perioperative complication and comorbidity data were collected to assess for associations with DM using logistic regression models. Odds ratios (ORs) and 95% confidence intervals were computed.
A total of 440 patients (238 men, mean age, 56.43 ± 13.28 years; mean body mass index, 30.80 ± 6.65 kg/m) met the study criteria. The HbA1c was <5.7% in 206 patients (46.8%), 5.7%-6.4% in 148 (33.6%), 6.5%-7.9% in 64 (14.5%), and ≥8.0% in 23 patients (5.22%). Bivariate logistic modeling showed that patients with poorly controlled DM had a higher risk of complications (OR, 2.92) than did the patients with DM (OR, 2.13). Malignancy (OR, 2.62) and hypertension (OR, 1.86) were also significant risk factors for complications. However, smoking (OR, 0.83) was not significant. Poorly controlled DM remained associated with complications in multivariable logistic regression modeling (OR, 2.72).
Poorly control DM defined by the preoperative HbA1c was significantly associated with postoperative complications. Smoking, however, was not so associated. Preoperative HbA1c can be used to assess the risk of postoperative spine surgery complications.
糖尿病（DM）与围手术期并发症的发生率增加有关。血红蛋白 A1c（HbA1c）的测量在脊柱手术的术前评估中并未常规进行。
在本单中心前瞻性研究中，2016 年至 2018 年期间，HbA1c 检测被纳入接受脊柱手术患者的术前实验室检查。HbA1c 水平根据美国糖尿病协会指南分为正常（HbA1c<5.7%）、前驱糖尿病（HbA1c 5.7%-6.4%）和糖尿病（HbA1c>6.5%）。HbA1c≥8%的患者被分离出来进行分析，以评估其 DM 控制不佳的情况。收集围手术期并发症和合并症数据，使用逻辑回归模型评估 DM 与这些并发症之间的关系。计算比值比（OR）和 95%置信区间。
共有 440 名患者（238 名男性，平均年龄 56.43±13.28 岁；平均体重指数 30.80±6.65kg/m）符合研究标准。206 名患者（46.8%）的 HbA1c<5.7%，148 名患者（33.6%）的 5.7%-6.4%，64 名患者（14.5%）的 6.5%-7.9%，23 名患者（5.22%）的≥8.0%。双变量逻辑模型显示，DM 控制不佳的患者发生并发症的风险较高（OR，2.92），DM 患者的风险（OR，2.13）较高。恶性肿瘤（OR，2.62）和高血压（OR，1.86）也是并发症的显著危险因素。然而，吸烟（OR，0.83）则无显著意义。在多变量逻辑回归模型中，DM 控制不佳仍与并发症相关（OR，2.72）。
术前 HbA1c 定义的 DM 控制不佳与术后并发症显著相关。然而，吸烟与并发症无显著相关性。术前 HbA1c 可用于评估脊柱手术后并发症的风险。
