Goheer Haseeb E, Newcomb Alden H, Johnson Zachary M, Hendrix Christopher G, Garcia Alexander R, Truong Brian Q, Carmouche Jonathan J
Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Roanoke, Virginia, USA.
J Craniovertebr Junction Spine. 2025 Apr-Jun;16(2):237-242. doi: 10.4103/jcvjs.jcvjs_59_25. Epub 2025 Jul 3.
Lumbar spine surgery procedures have been increasing amid a growing population with diabetes mellitus (DM) with limited studies available focusing exclusively on insulin dependence as a risk factor. The objective of this study was to evaluate the differential impact of insulin dependence on perioperative outcomes following lumbar spine surgery.
The American College of Surgeons National Surgical Quality Improvement Program database was queried to retrospectively identify patients who had undergone lumbar spine surgery between 2011 and 2022. The study population was divided into three distinct groups based on diabetic status: insulin-dependent DM (IDDM), insulin-independent DM (NIDDM), and no DM (non-DM). One-way analysis of variance for continuous variables and Chi-square tests for categorical variables were used to identify differences in perioperative variables between the three groups. Multivariable logistic regression analysis assessed the effect of DM status on postoperative surgical outcomes.
A total of 349,520 lumbar spine patients were identified, of whom 20,159 were IDDM, 43,402 were NIDDM, and 285,959 were non-DM. Both IDDM (odds ratio [OR]: OR: 1.134, 95% CI [1.059-1.214]) independently increased the risk for surgical complications, whereas only IDDM increased the risk for medical (OR: 1.256, 95% CI [1.194-1.320] complications following a multivariate logistic regression analysis.
This study highlights the increased risk of surgical and medical complications in patients with IDDM undergoing lumbar spine surgery. Both NIDDM and IDDM are independent risk factors for postoperative medical and surgical complications. These findings can be used to improve preoperative management and risk stratification for insulin dependent DM patients.
在糖尿病（DM）患者日益增多的情况下，腰椎手术的数量一直在增加，但专门关注胰岛素依赖作为危险因素的研究有限。本研究的目的是评估胰岛素依赖对腰椎手术后围手术期结果的不同影响。
查询美国外科医师学会国家外科质量改进计划数据库，以回顾性识别2011年至2022年间接受腰椎手术的患者。根据糖尿病状态，将研究人群分为三个不同的组：胰岛素依赖型糖尿病（IDDM）、非胰岛素依赖型糖尿病（NIDDM）和无糖尿病（非DM）。连续变量采用单因素方差分析，分类变量采用卡方检验，以确定三组围手术期变量的差异。多变量逻辑回归分析评估糖尿病状态对术后手术结果的影响。
共识别出349,520例腰椎患者，其中20,159例为IDDM，43,402例为NIDDM，285,959例为非DM。IDDM（比值比[OR]：1.134，95%可信区间[CI][1.059 - 1.214]）均独立增加手术并发症风险，而多变量逻辑回归分析后仅IDDM增加医疗并发症风险（OR：1.256，95%CI[1.194 - 1.320]）。
本研究强调了IDDM患者接受腰椎手术时手术和医疗并发症风险增加。NIDDM和IDDM都是术后医疗和手术并发症的独立危险因素。这些发现可用于改善胰岛素依赖型糖尿病患者的术前管理和风险分层。
