Does diabetes affect outcome or reoperation rate after lumbar decompression or arthrodesis? A matched analysis of the Quality Outcomes Database data set

Presented at the 2023 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

James Mooney Department of Neurosurgery, University of Alabama at Birmingham, Alabama;

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Karim Rizwan Nathani Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;

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Daniel Zeitouni Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina;
Department of Neurosurgery, Atrium Health, Charlotte, North Carolina;

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Giorgos D. Michalopoulos Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;

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Michael Y. Wang Department of Neurosurgery, University of Miami, Florida;

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Domagoj Coric Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina;

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Andrew K. Chan Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;

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Daniel C. Lu Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California;

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Brandon A. Sherrod Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;

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Oren N. Gottfried Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina;

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Christopher I. Shaffrey Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina;

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Khoi D. Than Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina;

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Jacob L. Goldberg Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York;

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Ibrahim Hussain Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York;

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Michael S. Virk Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York;

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Nitin Agarwal Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

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Steven D. Glassman Norton Leatherman Spine Center, Louisville, Kentucky;

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Mark E. Shaffrey Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;

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Paul Park Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;

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Kevin T. Foley Department of Neurosurgery, University of Tennessee, Memphis, Tennessee;

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Dean Chou Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;

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Jonathan R. Slotkin Department of Neurosurgery, Geisinger Health, Danville, Pennsylvania;

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Luis M. Tumialán Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona;

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Cheerag D. Upadhyaya Department of Neurosurgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina;

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Eric A. Potts Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana;

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Kai-Ming G. Fu Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York;

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Regis W. Haid Atlanta Brain and Spine Care, Atlanta, Georgia;

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John J. Knightly Atlantic Neurosurgical Specialists, Morristown, New Jersey; and

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Praveen V. Mummaneni Department of Neurological Surgery, University of California, San Francisco, California;

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Erica F. Bisson Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;

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Anthony L. Asher Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina;

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Mohamad Bydon Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;

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OBJECTIVE

Diabetes mellitus (DM) is a known risk factor for postsurgical and systemic complications after lumbar spinal surgery. Smaller studies have also demonstrated diminished improvements in patient-reported outcomes (PROs), with increased reoperation and readmission rates after lumbar surgery in patients with DM. The authors aimed to examine longer-term PROs in patients with DM undergoing lumbar decompression and/or arthrodesis for degenerative pathology.

METHODS

The Quality Outcomes Database was queried for patients undergoing elective lumbar decompression and/or arthrodesis for degenerative pathology. Patients were grouped into DM and non-DM groups and optimally matched in a 1:1 ratio on 31 baseline variables, including the number of operated levels. Outcomes of interest were readmissions and reoperations at 30 and 90 days after surgery in addition to improvements in Oswestry Disability Index, back pain, and leg pain scores and quality-adjusted life-years at 90 days after surgery.

RESULTS

The matched decompression cohort comprised 7836 patients (3236 [41.3] females) with a mean age of 63.5 ± 12.6 years, and the matched arthrodesis cohort comprised 7336 patients (3907 [53.3%] females) with a mean age of 64.8 ± 10.3 years. In patients undergoing lumbar decompression, no significant differences in nonroutine discharge, length of stay (LOS), readmissions, reoperations, and PROs were observed. In patients undergoing lumbar arthrodesis, nonroutine discharge (15.7% vs 13.4%, p < 0.01), LOS (3.2 ± 2.0 vs 3.0 ± 3.5 days, p < 0.01), 30-day (6.5% vs 4.4%, p < 0.01) and 90-day (9.1% vs 7.0%, p < 0.01) readmission rates, and the 90-day reoperation rate (4.3% vs 3.2%, p = 0.01) were all significantly higher in the DM group. For DM patients undergoing lumbar arthrodesis, subgroup analyses demonstrated a significantly higher risk of poor surgical outcomes with the open approach.

CONCLUSIONS

Patients with and without DM undergoing lumbar spinal decompression alone have comparable readmission and reoperation rates, while those undergoing arthrodesis procedures have a higher risk of poor surgical outcomes up to 90 days after surgery. Surgeons should target optimal DM control preoperatively, particularly for patients undergoing elective lumbar arthrodesis.

ABBREVIATIONS

DM = diabetes mellitus; LOS = length of stay; MCID = minimal clinically important difference; MIS = minimally invasive surgery; NRS = numeric rating scale; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QALY = quality-adjusted life-year; QOD = Quality Outcomes Database.
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Images from Özer and Demirtaş (pp 351–358).
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