Mariscal Gonzalo, Sasso Rick C, O'Toole John E, Chaput Christopher D, Steinmetz Michael P, Arnold Paul M, Witiw Christopher D, Jacobs W Bradley, Harrop James S
Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain.
Department Orthopaedic Surgery, Indiana Spine Group, Indiana University School of Medicine, Carmel, Indiana, USA.
Eur Spine J. 2025 Mar;34(3):935-953. doi: 10.1007/s00586-024-08631-w. Epub 2025 Jan 3.
This study aimed at comparing the costs of spinal fusion surgery between patients with and without diabetes.
Following PRISMA guidelines, a systematic search of four databases was conducted. A meta-analysis was performed on comparative studies examining diabetic versus non-diabetic adults undergoing cervical/lumbar fusion in terms of cost. Heterogeneity was assessed using the I2 test. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model in the presence of heterogeneity.
Twenty-two studies were included in this meta-analysis. Standardized costs were significantly higher in the diabetic group (SMD 0.02, 95% CI 0.01 to 0.03, p < 0.05). The excess cost per diabetic patient undergoing spinal fusion surgery was estimated to be $2,492 (95% CI: $1,620 to $3,363). The length of stay (LOS) was significantly longer in the diabetes group (MD 0.42, 95% CI 0.24 to 0.60, p < 0.001). No significant difference was observed in intensive care unit admission between the groups (OR 4.15, 95% CI 0.55 to 31.40, p > 0.05). Reoperation showed no significant differences between the groups (OR 1.14, 95% CI 0.96 to 1.35, p > 0.05). However, 30-day and 90-day readmissions were significantly higher in the diabetes group: (OR 1.42, 95% CI 1.24 to 1.62, p < 0.05) and (OR 1.39, 95% CI 1.15 to 1.68, p < 0.001), respectively. Non-routine or non-home discharge was also significantly higher in the diabetes group (OR 1.89, 95% CI 1.67 to 2.13, p < 0.001).
Patients with diabetes undergoing spinal fusion surgery had increased costs, prolonged LOS, increased 30-day/90-day readmission rates, and more frequent non-routine discharges.
本研究旨在比较糖尿病患者与非糖尿病患者进行脊柱融合手术的费用。
按照PRISMA指南，对四个数据库进行了系统检索。对比较糖尿病与非糖尿病成年人接受颈椎/腰椎融合手术费用的研究进行了荟萃分析。使用I2检验评估异质性。在存在异质性的情况下，使用随机效应模型计算标准化平均差（SMD）和比值比（OR）以及95%置信区间（CI）。
本荟萃分析纳入了22项研究。糖尿病组的标准化费用显著更高（SMD 0.02，95% CI 0.01至0.03，p < 0.05）。估计每位接受脊柱融合手术的糖尿病患者的额外费用为2492美元（95% CI：1620美元至3363美元）。糖尿病组的住院时间（LOS）显著更长（MD 0.42，95% CI 0.24至0.60，p < 0.001）。两组之间在重症监护病房入院方面未观察到显著差异（OR 4.15，95% CI 0.55至31.40，p > 0.05）。再次手术在两组之间无显著差异（OR 1.14，95% CI 0.96至1.35，p > 0.05）。然而，糖尿病组的30天和90天再入院率显著更高：分别为（OR 1.42，95% CI 1.24至1.62，p < 0.05）和（OR 1.39，95% CI 1.15至1.68，p < 0.001）。糖尿病组的非常规或非家庭出院情况也显著更多（OR 1.89，95% CI 1.67至2.13，p < 0.001）。
接受脊柱融合手术的糖尿病患者费用增加、住院时间延长、30天/90天再入院率升高且非常规出院更频繁。
