Maman David, Mahamid Assil, Nisanov Gabriel, Fagbamila Oluwaseun, Sleiman Ali, Shpigelman Arsen, Berkovich Yaron
Carmel Medical Center, Haifa 3436212, Israel.
Faculty of Medicine, Technion Israel Institute of Technology, Haifa 2611001, Israel.
J Clin Med. 2025 Apr 28;14(9):3039. doi: 10.3390/jcm14093039.
Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical radiculopathy and myelopathy. While generally effective, diabetes mellitus may increase postoperative complications and healthcare costs. This study evaluated the impact of type 2 diabetes on perioperative outcomes in ACDF patients. A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016-2019), including 85,585 single-level ACDF patients. Propensity score matching (PSM) was applied, creating two balanced cohorts (16,260 diabetic and 16,260 non-diabetic patients). Outcomes analyzed included postoperative complications, length of stay, hospital charges, and mortality. Diabetic patients had significantly higher risks of ACDF-specific complications, including cerebrospinal fluid leaks (2×), dysphagia (2.5×), dysphonia (2.9×), and cervical spinal cord injury (5×). General complications were also increased, with higher rates of pulmonary embolism (2.4×), sepsis (3×), stroke (3×), pneumonia (3.3×), and heart failure (12×). Diabetic patients had longer hospital stays (1.99 vs. 1.79 days, < 0.001) and higher hospital charges (USD 71,884 vs. USD 67,998, = 0.004). T2DM significantly increases postoperative risks, length of stay, and costs for ACDF patients. Optimized perioperative management and glucose control are essential to improve outcomes in this high-risk population.
颈椎前路椎间盘切除融合术（ACDF）是治疗神经根型颈椎病和脊髓型颈椎病的常用方法。虽然总体有效，但糖尿病可能会增加术后并发症和医疗费用。本研究评估了2型糖尿病对ACDF患者围手术期结局的影响。使用全国住院患者样本（2016 - 2019年）进行了一项回顾性队列研究，纳入85,585名单节段ACDF患者。应用倾向评分匹配（PSM），创建了两个平衡队列（16,260名糖尿病患者和16,260名非糖尿病患者）。分析的结局包括术后并发症、住院时间、住院费用和死亡率。糖尿病患者发生ACDF特异性并发症的风险显著更高，包括脑脊液漏（2倍）、吞咽困难（2.5倍）、发音障碍（2.9倍）和颈脊髓损伤（5倍）。一般并发症也有所增加，肺栓塞（2.4倍）、脓毒症（3倍）、中风（3倍）、肺炎（3.3倍）和心力衰竭（12倍）的发生率更高。糖尿病患者的住院时间更长（1.99天对1.79天，<0.001），住院费用更高（71,884美元对67,998美元，=0.004）。2型糖尿病显著增加了ACDF患者的术后风险、住院时间和费用。优化围手术期管理和血糖控制对于改善这一高危人群的结局至关重要。
