Khoylyan Ara, Coleman Noah, Parry Matthew, Tang Alex, Chen Tan
Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA.
Geisinger Northeast Orthopaedic Surgery Residency, Wilkes-Barre, PA 18711, USA.
J Clin Med. 2025 Jun 28;14(13):4589. doi: 10.3390/jcm14134589.
Retrospective Cohort Study. The objectives of this study are to (1) compare post-operative patient-reported outcome measures (PROMs) between non-diabetic (non-DM) and diabetic (DM) patients undergoing Anterior Cervical Discectomy and Fusion (ADCF), (2) characterize the clinical trajectory, and (3) compare the rate of post-operative complications. A total of 261 non-DM and 52 DM patients were included. Patient demographics, Neck Disability Index (NDI) and Patient-Recorded Outcomes Measurement Information System (PROMIS) scores were collected up to one year after operation. Maximum medical improvement (MMI) was defined as the timepoint where more than 90% of the cohort achieved a minimal clinically important difference (MCID) in survey scores. Post-operative complications were collected. Descriptive and inferential statistics were performed. Non-DM patients achieve MMI significantly more quickly than DM patients (non-DM: 6 months; DM: 1 year, < 0.010). No difference in ∆NDI (non-DM: 24.9; DM: 23.0; = 0.824) or ∆PROMIS-Physical Function (non-DM: 7.1; DM: 9.1; = 0.373) was found between the two cohorts. In diabetic patients undergoing single-level fusion ACDF, a pre-operative HbA1c of ≥7.3% demonstrates 100% sensitivity and 25% specificity in detecting failure to achieve 1-year PROMIS MCID (AUC = 0.833, = 0.009). There was no association between diabetic status and post-operative complication rate. Diabetic patients may demonstrate a slower rate of achieving maximum medical improvement despite equal subjective and clinical outcomes. Pre-operative HbA1c ≥ 7.3% demonstrates a significant correlation with worse subjective outcomes following single-level ACDF.
回顾性队列研究。本研究的目的是：（1）比较接受颈椎前路椎间盘切除融合术（ACDF）的非糖尿病（非DM）患者和糖尿病（DM）患者术后患者报告的结局指标（PROMs）；（2）描述临床病程；（3）比较术后并发症发生率。共纳入261例非DM患者和52例DM患者。收集患者的人口统计学数据、颈部残疾指数（NDI）和患者记录的结局测量信息系统（PROMIS）评分，随访至术后1年。最大医学改善（MMI）定义为超过90%的队列患者在调查评分中达到最小临床重要差异（MCID）的时间点。收集术后并发症情况。进行描述性和推断性统计分析。非DM患者达到MMI的速度明显快于DM患者（非DM：6个月；DM：1年，P<0.010）。两组患者的NDI变化量（非DM：24.9；DM：23.0；P = 0.824）或PROMIS身体功能变化量（非DM：7.1；DM：9.1；P = 0.373）无差异。在接受单节段融合ACDF的糖尿病患者中，术前糖化血红蛋白（HbA1c）≥7.3%在检测未达到1年PROMIS MCID方面的敏感性为100%，特异性为25%（曲线下面积[AUC]=0.833，P = 0.009）。糖尿病状态与术后并发症发生率之间无关联。尽管主观和临床结局相同，但糖尿病患者达到最大医学改善的速度可能较慢。术前HbA1c≥7.3%与单节段ACDF术后较差的主观结局显著相关。
