The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China.
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China.
Int J Surg. 2022 Aug;104:106789. doi: 10.1016/j.ijsu.2022.106789. Epub 2022 Jul 31.
Although diabetes mellitus (DM) is considered to be an important prognostic factor in spinal surgery, the relationship between these two factors remains unclear. The purpose of this study was to investigate whether diabetes is associated with an increased risk of postoperative complications in patients undergoing spinal surgery.
We systematically searched the PubMed, Embase, and Cochrane Library for relevant articles published on or before December 25, 2021. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects meta-analysis. The primary outcome was the risk of postoperative complications following spinal surgery, including postoperative infection and reoperation. Furthermore, we conducted subgroup analyses and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results.
A total of 40 cohort studies including 2,998,891 participants met the inclusion criteria. Meta-analysis showed that diabetes was significantly associated with postoperative infection (OR 2.21, 95% CI 1.70-2.88, p < 0.001) and reoperation (OR 1.35, 95% CI 1.12-1.64, p = 0.002). Furthermore, the results also found that diabetes was significantly associated with surgery-related death (OR 1.61, 95% CI 1.13-2.30, p = 0.008) and transfusions (OR 1.39, 95% CI 1.11-1.75, p = 0.005), whereas diabetes failed to account for nervous system complications (OR 1.12, 95% CI 0.82-1.52, p = 0.470) and embolism (OR 1.15, 95% CI 0.83-1.60, p = 0.386) for patients following spine surgery. These results were further confirmed by the trim-and-fill procedure and leave-one-out sensitivity analyses.
Diabetes appears to be a risk factor for postoperative infection and reoperation for patients following spinal surgery. Special attention should be devoted to reducing the occurrence of postoperative complications in diabetic patients undergoing spinal surgery.
虽然糖尿病（DM）被认为是脊柱手术中的一个重要预后因素，但这两个因素之间的关系仍不清楚。本研究旨在探讨糖尿病是否与脊柱手术后并发症风险增加有关。
我们系统地检索了 PubMed、Embase 和 Cochrane Library 中截至 2021 年 12 月 25 日发表的相关文章。使用随机效应荟萃分析计算合并优势比（OR）及其 95%置信区间（CI）。主要结局是脊柱手术后的并发症风险，包括术后感染和再次手术。此外，我们进行了亚组分析和逐一剔除敏感性分析，以探讨主要异质性来源和结果的稳定性。
共有 40 项队列研究纳入了 2998891 名参与者。Meta 分析表明，糖尿病与术后感染（OR 2.21，95%CI 1.70-2.88，p<0.001）和再次手术（OR 1.35，95%CI 1.12-1.64，p=0.002）显著相关。此外，结果还发现，糖尿病与手术相关死亡（OR 1.61，95%CI 1.13-2.30，p=0.008）和输血（OR 1.39，95%CI 1.11-1.75，p=0.005）显著相关，但糖尿病与神经系统并发症（OR 1.12，95%CI 0.82-1.52，p=0.470）和栓塞（OR 1.15，95%CI 0.83-1.60，p=0.386）无关。这些结果通过修剪和填补程序和逐一剔除敏感性分析得到进一步证实。
糖尿病似乎是脊柱手术后患者术后感染和再次手术的危险因素。对于接受脊柱手术的糖尿病患者，应特别注意降低术后并发症的发生。
