Liao Yuan-Jing, Xu Lan-Wei, Xie Hao, Yang Qin-Feng, Wang Jian, Fan Lei, Cao Sheng-Lu
Department of Orthopedics, Division of Spine Surgery, Nanfang Hospital, Southern Medical University.
Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University.
Int J Surg. 2025 Jan 1;111(1):178-189. doi: 10.1097/JS9.0000000000002027.
Diabetes mellitus (DM) is a prevalent chronic condition that influences spine surgery outcomes. The impact of type Ⅰ and type Ⅱ DM on adverse postoperative outcomes, mortality, prolonged length of stay (LOS), and increased in-hospital costs following cervical fusion surgery remains unclear in the past decade. This study aims to determine the specific effect of different classifications of DM on postoperative complications in patients experiencing cervical fusion surgery.
Data from the Nationwide Inpatient Sample database was acquired between 2010 and 2019. Patients experiencing cervical fusion were included and classified as having type I DM, type II DM, or neither. Patient demographics, hospital characteristics, operative variables, comorbidities, complications, and other postoperative outcomes were assessed. Propensity score matching analysis was used to balance baseline differences. Univariate and multivariate logistic regression were employed to determine the risk of postoperative outcomes in patients with different classifications of DM.
A total of 267 174 cervical spinal fusions were identified (224 255 were patients without DM, 670 patients had type I DM, and 42 249 patients had type II DM). After propensity score matching, the multivariate analysis of non-DM and type I DM patients shows a significant difference in pneumonia ( P =0.020). However, type Ⅱ DM served as an independent predictor of an increased risk of acute cerebrovascular disease ( P =0.001), acute myocardial infarction ( P =0.014), pneumonia ( P =0.045), continuous trauma ventilation ( P =0.016), chest pain ( P <0.001), urinary tract infection ( P <0.001), transfusion ( P =0.005) and dysphagia ( P =0.013), prolonged LOS ( P <0.001), and increased costs ( P =0.008).
Using non-DM patients as a reference, the type II DM group demonstrated a higher risk of postoperative complications than the type I DM group among patients receiving cervical fusion surgery. This vital distinction could enhance risk stratification and guidance for patients diagnosed with DM before cervical fusion surgery.
糖尿病（DM）是一种常见的慢性病，会影响脊柱手术的结果。在过去十年中，Ⅰ型和Ⅱ型糖尿病对颈椎融合手术后的不良术后结果、死亡率、住院时间延长（LOS）以及住院费用增加的影响尚不清楚。本研究旨在确定不同分类的糖尿病对颈椎融合手术患者术后并发症的具体影响。
收集2010年至2019年期间全国住院患者样本数据库中的数据。纳入接受颈椎融合手术的患者，并将其分为患有Ⅰ型糖尿病、Ⅱ型糖尿病或两者都没有。评估患者的人口统计学特征、医院特征、手术变量、合并症、并发症和其他术后结果。采用倾向得分匹配分析来平衡基线差异。采用单因素和多因素逻辑回归分析来确定不同分类糖尿病患者术后结果的风险。
共确定了267174例颈椎融合手术患者（224255例患者无糖尿病，670例患者患有Ⅰ型糖尿病，42249例患者患有Ⅱ型糖尿病）。在倾向得分匹配后，非糖尿病和Ⅰ型糖尿病患者的多因素分析显示肺炎存在显著差异（P = 0.020）。然而，Ⅱ型糖尿病是急性脑血管疾病（P = 0.001）、急性心肌梗死（P = 0.014）、肺炎（P = 0.045）、持续创伤通气（P = 0.016）、胸痛（P < 0.001）、尿路感染（P < 0.001）、输血（P = 0.005）和吞咽困难（P = 0.013）、住院时间延长（P < 0.001）和费用增加（P = 0.008）风险增加的独立预测因素。
以非糖尿病患者为参照，在接受颈椎融合手术的患者中，Ⅱ型糖尿病组术后并发症的风险高于Ⅰ型糖尿病组。这一重要区别可以加强对颈椎融合手术前诊断为糖尿病患者的风险分层和指导。
