Bajaj Anitesh, Shah Rohan M, Brecount Hogan, Kurapaty Steven, Patel Alpesh A, Divi Srikanth N
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
Curr Rev Musculoskelet Med. 2023 Feb;16(2):39-47. doi: 10.1007/s12178-022-09814-y. Epub 2022 Dec 28.
Diabetes and metabolic syndrome are highly prevalent in patients undergoing spine surgery. This review aims to capture both the findings of recently published literature investigating the effects of diabetes and metabolic syndrome on spine surgery outcomes and the current best practices in patient management.
Diabetes and metabolic syndrome both contribute to worse outcomes in patients undergoing spine surgery. Although patients with diabetes are at greater risk of complications, those with uncontrolled diabetes experience increased healthcare costs and greater odds of postoperative complications. Furthermore, metabolic syndrome is repeatedly shown to have an adverse effect on spine surgery outcomes, including healthcare costs and medical complications. Spine surgeons should coordinate care with primary care physicians to optimize the preoperative profile of patients with comorbidities like diabetes and metabolic syndrome to minimize operative risk. With the shift to value-based care, understanding the patient factors that lead to complications is becoming increasingly important. Future studies should build upon the current literature and design preoperative interventions for at-risk patients. Additionally, further research is needed to analyze the modulatory effects of the social determinants of health in patients with diabetes and metabolic syndrome.
糖尿病和代谢综合征在接受脊柱手术的患者中极为普遍。本综述旨在总结近期发表的关于糖尿病和代谢综合征对脊柱手术结局影响的文献研究结果以及目前患者管理的最佳实践。
糖尿病和代谢综合征均会导致接受脊柱手术的患者出现更差的结局。尽管糖尿病患者发生并发症的风险更高,但血糖控制不佳的患者会增加医疗费用,且术后并发症的几率更大。此外,代谢综合征反复被证明会对脊柱手术结局产生不利影响,包括医疗费用和医疗并发症。脊柱外科医生应与初级保健医生协调护理,以优化患有糖尿病和代谢综合征等合并症患者的术前状况,从而将手术风险降至最低。随着向基于价值的医疗转变,了解导致并发症的患者因素变得越来越重要。未来的研究应在现有文献的基础上,为高危患者设计术前干预措施。此外,还需要进一步研究来分析健康的社会决定因素对糖尿病和代谢综合征患者的调节作用。