The effect of diabetes on perioperative complications following spinal surgery: a meta-analysis

Luo, Wei; Sun, Ru-xin; Jiang, Han

doi:10.2147/tcrm.s185221

Cited by 28 publications

(17 citation statements)

References 37 publications

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“…15,18,28 Possibly, worse baseline disability may be related to smaller improvement in disability after surgery as a continuous outcome, 52,64 but not as MCID. 54,65 Medical comorbidities are known to increase the risk of postoperative complications, 71,72 however, their effect on longer-term spinal surgery outcomes is less clear. 19,73 We found very low-quality evidence supporting significant associations between present comorbidities and smaller benefit from surgery in terms of reduction in pain, but not disability (low-quality).…”

Section: Health-related Predictorsmentioning

confidence: 99%

Predictors of Pain and Disability Outcomes Following Spinal Surgery for Chronic Low Back and Radicular Pain

Halicka¹,

Duarte²,

Catherall

et al. 2022

The Clinical Journal of Pain

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Objectives: Success rates of spinal surgeries to treat chronic back pain are highly variable and useable prognostic indicators are lacking. We aimed to identify and evaluate preoperative predictors of pain and disability after spinal surgery for chronic low back/ leg pain.Methods: Electronic database (01/1984-03/2021) and reference searches identified 2622 unique citations. Eligible studies included adults with chronic low back/leg pain lasting ≥ 3 months undergoing first elective lumbar spine surgery, and outcomes defined as change in pain (primary)/disability (secondary) after ≥ 3 months. We included 21 reports (6899 participants), 7 were judged to have low and 14 high risks of bias. We performed narrative synthesis and determined the quality of evidence (QoE).Results: Better pain outcomes were associated with younger age, higher education, and no spinal stenosis (low QoE); lower preoperative pain, fewer comorbidities, lower pain catastrophizing, anxiety and depression (very low QoE); but not with symptom duration (moderate QoE), other sociodemographic factors (low QoE), disability, or sensory testing (very low QoE). More favorable disability outcomes were associated with preoperative sensory loss (moderate QoE); lower job-related resignation and neuroticism (very low QoE); but not with socioeconomic factors, comorbidities (low QoE), demographics, pain, or pain-related psychological factors (very low QoE).Discussion: In conclusion, absence of spinal stenosis potentially predicts greater pain relief and preoperative sensory loss likely predicts reduction in disability. Overall, QoE for most identified associations was low/very low.

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Section: Health-related Predictorsmentioning

confidence: 99%

Predictors of Pain and Disability Outcomes Following Spinal Surgery for Chronic Low Back and Radicular Pain

Halicka¹,

Duarte²,

Catherall

et al. 2022

The Clinical Journal of Pain

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“…Patients with DM are at greater risk for complications from reconstructive surgeries and fractures due to nonhealing of bone. This can lead to expensive revision surgeries, infections, and amputations, particularly in the lower extremity, [ 58–60 ] resulting in substantial morbidity, effects on personal and family lifestyles, and financial cost. Further studies are needed to assess bone regeneration capacity of the composite biomaterial in bone lesions.…”

Section: Resultsmentioning

confidence: 99%

A Multi‐Functional Implant Induces Bone Formation in a Diabetic Model

Khorsand

Acri

et al. 2020

Adv Healthcare Materials

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Patients with diabetes mellitus (DM) have defective healing of bone fractures. It was previously shown that nonviral gene delivery of plasmid DNA (pDNA) that independently encodes bone morphogenetic protein‐2 (BMP‐2) and fibroblast growth factor‐2 (FGF‐2), acts synergistically to promote bone regeneration in a DM animal model. Additionally, both insulin (INS) and the hormonally active form of vitamin D3, 1α,25‐dihydroxyvitamin D3 (1α,25(OH)2D3) (VD3) have independently been shown to play key roles in regulating bone fracture healing in DM patients. However, these individual therapies fail to adequately stimulate bone regeneration, illustrating a need for novel treatment of bone fractures in diabetic patients. Here, the ability of local delivery of INS and VD3 along with BMP‐2 and FGF‐2 genes is investigated to promote bone formation ectopically in Type‐2 diabetic rats. A composite consisting of VD3 and INS is developed that contains poly(lactic‐co‐glycolic acid) microparticles (MPs) embedded in a fibrin gel surrounded by a collagen matrix that is permeated with polyethylenimine (PEI)‐(pBMP‐2+pFGF‐2) nanoplexes. Using a submuscular osteoinduction model, it is demonstrated that local delivery of INS, VD3, and PEI‐(pBMP‐2+pFGF‐2) significantly improves bone generation compared to other treatments, thusimplicating this approach as a method to promote bone regeneration in DM patients with bone fractures.

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“…Obese patients having spinal surgery were found to have increased blood loss, prolonged hospital stay and were more likely to develop infection [ 76 , 77 ]. Patients with diabetes were found to have greater disability and more likely to have failed spinal fusion as compared to patients without diabetes [ 78 – 80 ]. Frailty is an emerging risk assessment tool, requiring further studies [ 81 ].…”

Section: Discussionmentioning

confidence: 99%

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

et al. 2021

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Background Enhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on available evidence. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review. Methods We included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). Following databases (1990 onwards) were searched: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two authors screened the citations, full-text articles, and extracted data. A narrative synthesis was provided. We constructed Evidence Profile (EP) tables for each component of the pathway, where appropriate information was available. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. GRADE system was used to classify confidence in cumulative evidence for each component of the pathway. Results We identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We identified specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables where suitable. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components. Conclusions We identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS. Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

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The effect of diabetes on perioperative complications following spinal surgery: a meta-analysis

Cited by 28 publications

References 37 publications

Predictors of Pain and Disability Outcomes Following Spinal Surgery for Chronic Low Back and Radicular Pain

Predictors of Pain and Disability Outcomes Following Spinal Surgery for Chronic Low Back and Radicular Pain

A Multi‐Functional Implant Induces Bone Formation in a Diabetic Model

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

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