BackgroundWe conducted a meta-analysis from randomized controlled trials (RCTs) and non-RCTs to assess the efficacy and safety of tranexamic acid (TXA) in spine surgery.MethodsPotentially relevant academic articles were identified from the Cochrane Library, MEDLINE (1966–2017.11), PubMed (1966–2017.11), Embase (1980–2017.11), and ScienceDirect (1985–2017.11). Secondary sources were identified from the references of the included literature. The pooled data were analyzed using RevMan 5.1.ResultsThree RCTs and one non-RCT met the inclusion criteria. There were significant differences in total blood loss (MD = − 267.53, 95% CI − 373.04 to − 106.02, P < 0.00001), drainage volume (MD = − 157.00, 95% CI − 191.17 to − 122.84, P < 0.00001), postoperative hemoglobin level (MD = 0.95, 95% CI 0.44 to 1.47, P = 0.0003), and length of hospital stay (MD = − 1.42, 95% CI − 1.92 to − 0.93, P < 0.00001). No significant differences were found regarding transfusion requirement, deep vein thrombosis (DVT), pulmonary embolism (PE), wound hematoma, and infection between the two groups.ConclusionsThe present meta-analysis indicated that the topical application of TXA in spinal surgery decreases the total blood loss and drainage volume and preserves higher postoperative hemoglobin level without increasing the risk of DVT infection, hematoma, DVT, and PE.

BackgroundDegenerative spinal diseases and diabetes mellitus (DM) have increasingly become a social and economic burden. The effect of DM on spinal surgery complications reported by previous studies remains controversial.MethodsWe searched MEDLINE, Cochrane CENTRAL, ScienceDirect, EMBASE, and Google Scholar to identify studies reporting the relationship between DM and spinal surgery complications. Two independent reviewers performed independent data abstraction. The I2 statistic was used to assess heterogeneity. A fixed-effects or random-effects model was used for the meta-analysis.ResultsTwenty-four studies met the inclusion criteria. Surgical site infection and the incidence of deep venous thrombosis after spinal surgery were significantly higher in patients with than in patients without diabetes, and the length of hospital stay was significantly longer in patients with diabetes (P<0.05). No significant differences were observed in the risk of reoperation, blood loss, and operation time between patients with and those without diabetes (P.0.05).ConclusionPatients with diabetes have a higher risk when undergoing spinal surgery than patients without diabetes. Diabetes increases the risks of postoperative mortality, surgical site infection, deep venous thrombosis, and a prolonged hospitalization time after spinal surgery.