Preoperative HbA1c &gt; 8% Is Associated With Poor Outcomes in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative Study

Lim, Seokchun; Yeh, Hsueh‐Han; Macki, Mohamed; Mansour, Tarek R; Schultz, Lonni; Telemi, Edvin; Haider, Sameah; Nerenz, David R.; Schwalb, Jason M.; Abdulhak, Muwaffak; Park, Paul; Aleem, Ilyas; Easton, Richard; Khalil, Jad G.; Perez-Cruet, Miguelangelo; Chang, Victor

doi:10.1093/neuros/nyab294

Cited by 13 publications

(24 citation statements)

References 37 publications

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“…At present, most studies have confirmed that glycosylated hemoglobin ≥6.5% (≥48 mmol/mol) can irremediable long-term risk for diabetic complications and mortality ( 19 ). Lim et al ( 20 ) analyzed 4,778 patients and showed that patients with preoperative hemoglobin A1c (HbA1c) > 8% were more likely to experience postoperative complication; indeed, in our study, glycosylated hemoglobin ≥6.5% was an independent risk factor affecting the satisfaction of OTCF patients, indicating that controlling HbA1C level <6.5% was beneficial. What's more, a systematic review showed that preoperativeHbA1c > 7.5 mg/dl was associated with an increased risk of reoperation or infection after spine surgery ( 21 ).…”

Section: Discussionsupporting

confidence: 58%

Clinical effect of kyphoplasty in the treatment of osteoporotic thoracolumbar compression fractures in patients with diabetes

et al. 2023

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ObjectiveTo study the clinical effect and influencing factors of kyphoplasty in the treatment of osteoporotic thoracolumbar compression fractures (OTCF) complicated with type 2 diabetes mellitus (T2DM).MethodsA total of 472 patients with OTCF complicated with diabetes who were enrolled in our hospital from January to December 2019 were selected as the study subjects, and all patients were treated with percutaneous kyphoplasty (PKP). The effects of gender, age, smoking, drinking, body mass index (BMI), bone mass density (T score), fasting blood glucose level, fasting C-peptide, glycosylated hemoglobin, course of T2DM, vertebral segment and surgical instrument on postoperative improvement were analyzed. The quality of life was evaluated by visual analog score (VAS) and Oswestry disability index (ODI) before PKP and 7 days, and 6 months after PKP, and the patient satisfaction was assessed by the modified Macnab criteria at 6 months postoperatively.ResultsThe overall excellent and good rate of evaluation result was satisfactory. In multivariate regression, independent risk factors for poor patient satisfaction included: age ≥70 years (odds ratio (OR) = 2.298, 95% confidence interval [CI] 1.290–4.245, P = 0.025), fasting blood glucose ≥8 mmol/L [OR = 2.657, 95%(CI) 1.288–4.121, P = 0.016], glycosylated hemoglobin ≥6.5 mmol/L [OR = 3.438, 95%(CI) 2.543–4.628, P = 0.001], duration ≥8 years [OR = 1.732, 95%(CI) 1.471–3.253, P = 0.019] and Kyphon instrument [OR = 1.472, 95%(CI) 1.112–2.228, P = 0.018] were independent influencing factors of OTCF complicated with DM.ConclusionKyphoplasty for patients with osteoporotic thoracolumbar compression fractures complicated with diabetes can achieve a satisfactory clinical effect, the curative effect is affected by many factors, attention to these factors can improve the clinical effect.

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Section: Discussionsupporting

confidence: 58%

Clinical effect of kyphoplasty in the treatment of osteoporotic thoracolumbar compression fractures in patients with diabetes

et al. 2023

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“…Despite the heterogeneity of outcome measures, results can be parsed based on preoperative HbA1c cutoff values ranging from 6.1% to 8.0%, utilized by 14 of 22 included studies, with 8.0% being the most frequently endorsed. Several studies have assessed preoperative HbA1c using a threshold of 8.0% and found increased likelihood for postoperative complications associated with HbA1c above this level 17,18,31 . This same cutoff is supported by the results of this meta-analysis, which demonstrated that patients with preoperative HbA1c over 8.0% have a 1.85 relative risk of developing postoperative complications compared to those with HbA1c under 8.0%.…”

Section: Discussionsupporting

confidence: 57%

“…Several studies have assessed preoperative HbA1c using a threshold of 8.0% and found increased likelihood for postoperative complications associated with HbA1c above this level. 17,18,31 This same cutoff is supported by the results of this meta-analysis, which demonstrated that patients with preoperative HbA1c over 8.0% have a 1.85 relative risk of developing postoperative complications compared to those with HbA1c under 8.0%. Although an HbA1c above 8.0% is associated with an increased risk of overall complications, further research is needed to determine whether this is the optimal threshold value.…”

Section: Discussionmentioning

confidence: 54%

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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“…Preoperative short-term glucose control has been associated with wound complications [ 24 ], myocardial injury after noncardiac surgery, and 30-day mortality [ 25 ]. Likewise, preoperative long-term glucose control has been associated with postoperative complications and long-term survival [ 26 , 27 ]. There is no consensus on which strategy of perioperative glycemic control is better for improving perioperative complications of patients undergoing surgery [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Postinduction Blood Glucose on Intraoperative Hypothermia

2023

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Background and Objectives: Hypothermia frequently occurs in patients undergoing surgery and is associated with adverse complications. Therefore, this study aimed to investigate the postinduction blood glucose and occurrence of intraoperative hypothermia in patients undergoing laparoscopic surgery. Materials and Methods: This retrospective observational study included 334 patients aged ≥20 years who had undergone elective laparoscopic surgery. The primary outcome of this study was the incidence of intraoperative hypothermia. Stratified analysis revealed differences between patients with and without diabetes. Results: Hypothermia occurred in 200 (59.9%) patients. In multivariate analysis, out-of-range postinduction glucose was independently associated with hypothermia (>150 mg/dL: odds ratio 2.17, 95% confidence interval (1.02, 4.61), p = 0.045; <110 mg/dL: odds ratio 2.02, 95% confidence interval (1.15, 3.55), p = 0.015), whereas preoperative HbA1c >6% was not significantly associated with hypothermia (odds ratio 1.02, 95% confidence interval (0.56, 1.84), p = 0.961). Considering only patients with diabetes, the incidence of hypothermia was lower (p = 0.002), the duration of hypothermia was shorter (p = 0.007), and the minimum temperature was higher (p = 0.006) in those with a postinduction glucose level of 110–150 mg/dL. Conclusions: The postinduction glucose level is independently associated with intraoperative hypothermia. Out-of-range postinduction glucose appeared to have an impact on the development of hypothermia in patients with diabetes, especially those with a postinduction glucose level <110 mg/dL.

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Preoperative HbA1c > 8% Is Associated With Poor Outcomes in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative Study

Cited by 13 publications

References 37 publications

Clinical effect of kyphoplasty in the treatment of osteoporotic thoracolumbar compression fractures in patients with diabetes

Clinical effect of kyphoplasty in the treatment of osteoporotic thoracolumbar compression fractures in patients with diabetes

Preoperative HbA1c and Postoperative Outcomes in Spine Surgery

The Effect of Postinduction Blood Glucose on Intraoperative Hypothermia

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