Optimal hemoglobin A1C target in diabetics undergoing elective cervical spine surgery

Roth, Steven G.; Chanbour, Hani; Gupta, Rishabh; O’Brien, Alexander G.; Davidson, Claudia; Archer, Kristin R.; Pennings, Jacquelyn S.; Devin, Clinton J.; Stephens, Byron F.; Abtahi, Amir M.; Zuckerman, Scott L.

doi:10.1016/j.spinee.2022.02.014

Cited by 10 publications

(12 citation statements)

References 31 publications

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“… 25 Walid et al found that patients with HbA1c ≥6.1% had an increased total hospital cost ($36748 vs. $28363, Table 2) despite no significant increase in LOS 32 . One study of outcomes in posterior cervical laminectomy and fusion found no association between HbA1c and PROs, such as MCID NRS-Neck, MCID NRS-Arm, and MCID NDI, or for readmission 16 . Two studies found no correlations between preoperative HbA1c and recovery ratio or JOA scores in patients with cervical myelopathy 20,22 …”

Section: Resultsmentioning

confidence: 99%

“…32 One study of outcomes in posterior cervical laminectomy and fusion found no association between HbA1c and PROs, such as MCID NRS-Neck, MCID NRS-Arm, and MCID NDI, or for readmission. 16 Two studies found no correlations between preoperative HbA1c and recovery ratio or JOA scores in patients with cervical myelopathy. 20,22 Thoracic and Lumbar Spine Surgery…”

Section: Meta-analysis Of Outcomesmentioning

confidence: 98%

“…These studies found that higher HbA1c was associated with worse PROs. 16,17,24 Cervical Spine Surgery…”

Section: Meta-analysis Of Outcomesmentioning

confidence: 99%

“…Therefore, 22 fully extracted primary studies, all categorized as level IIB of evidence or higher were available for meta-analysis (Table 1). [6][7][8][9][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Quality assessment returned a rating of "Good" for all included studies according to the Joanna Briggs Institute checklists (Supplementary Figure 1, Supplemental Digital Content 2, http://links.lww.com/BRS/C95), predisposing this study to a low risk of bias overall. Publication bias was not assessed because fewer than ten studies were included.…”

Section: Study Selectionmentioning

confidence: 99%

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Preoperative HbA1c and Postoperative Outcomes in Spine Surgery

Tao

Matur

Palmisciano

et al. 2023

Spine

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Study Design. Systematic review and meta-analysis. Objective. To perform a systematic review and meta-analysis of previous studies on HbA1c in preoperative risk stratification in patients undergoing spinal procedures and provide an overview of the consensus recommendations. Summary of Background Data. Diabetes mellitus (DM) and hyperglycemia have been shown to be independent risk factors for increased surgical complications. Glycated Hemoglobin A1C (HbA1c), a surrogate for long term glycemic control, is an important preoperative parameter that may be optimized to reduce surgical complications and improve patient-reported outcomes. However, comprehensive systematic reviews on preoperative HbA1c and postoperative outcomes in spine surgery have been limited. Methods. We systematically searched PubMed, EMBASE, Scopus, and Web-of-Science for English-language studies from inception through April 5th, 2022, including references of eligible articles. The search was conducted according to PRISMA guidelines. Only studies in patients undergoing spine surgery with preoperative HbA1c values and postoperative outcomes available were included. Results. A total of 22 articles (18 retrospective cohort studies, 4 prospective observational studies) were identified with level of evidence III or greater. The majority of studies (n=17) found that elevated preoperative HbA1c was associated with inferior outcomes or increased risk of complications. Random-effect meta-analysis demonstrated that patients with preoperative HbA1c >8.0% had increased risk(s) of postoperative complications (RR: 1.85, 95% CI: [1.48, 2.31], P<0.01) and that patients with surgical site infection (SSI) had higher preoperative HbA1c (Mean Difference: 1.49%, 95% CI: [0.11, 2.88], P=0.03). Conclusion. The findings of this study suggest that HbA1c >8.0% is associated with an increased risk of complications. HbA1c was higher by 1.49% on average among patients with SSI when compared to patients who did not experience SSI. These results suggest that elevated HbA1c is associated with less favorable outcomes following spine surgery. Level of Evidence. IV

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Section: Resultsmentioning

confidence: 99%

Section: Meta-analysis Of Outcomesmentioning

confidence: 98%

“…These studies found that higher HbA1c was associated with worse PROs. 16,17,24 Cervical Spine Surgery…”

Section: Meta-analysis Of Outcomesmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

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Preoperative HbA1c and Postoperative Outcomes in Spine Surgery

Tao

Matur

Palmisciano

et al. 2023

Spine

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“…Similarly, a study examining 105 diabetic patients with spondylotic myelopathy who underwent laminoplasty showed that HgbA1C% levels >6.5% was a significant risk factor (odds ratio, 2.591; P =0.0193) for poor surgical outcome [45]. A study examining outcomes in diabetic patients showed that HgbA1C% levels above 6.1% were associated with elevated risk (AUC=0.77, 95%CI 0.70-0.84, P<.001) of failure to achieve clinical improvement for patients who had undergone anterior cervical fusion or posterior cervical laminectomy and fusion [46]. That same study found that HgbA1C% levels above 6.8% may also be associated with increased odds of requiring reoperation (AUC=0.61, 95%CI 0.52-0.69, P =.078).…”

Section: Utility Of Glycated Hemoglobin (Hgba1c%) In Pre-operative Ev...mentioning

confidence: 99%

Diabetes management in spinal surgery

Michel

Lucke‐Wold

2022

J Clin Images Med Case Rep

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Diabetes mellitus can lead to long-standing complications in multiple arenas. An area that is often overlooked is implications for major surgery. Spinal decompression and fusions have unique challenges in the diabetic patient. In this review, we briefly highlight the pathophysiology of diabetes mellitus prior to examining implications for spinal surgery. We focus on the wound healing process, surgical infection risk, and delayed fusion. The paper then transitions to a focus on early diagnostics as well as pre-operative glucose control. Finally, we highlight important management strategies post operatively, continued necessity of monitoring, and emerging treatment and diagnostic approaches. This paper will serve as a key clinical guide that clinicians can utilize for diagnostic, management, and follow-up planning. Keywords: Diabetes mellitus; Spine surgery; Management considerations; Diagnostics.

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