320 Association Between Hemoglobin A1c and Reoperation Following Spine Surgery. (1st August 2016)

• Record Type: Journal Article
• Authors: Miller, Jacob A.; Webb, Matthew Richard; Benzel, Edward C.; Mroz, Thomas; Mayer, Eric
• Is Part Of: Neurosurgery. Volume 63:(2016)Supplement 1
• Page Start: 193
• Page End: 193
• Publication Date: 2016-08-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/01.neu.0000489809.44982.fb
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: In 2008, nearly 500 000 spine surgeries were performed in the United States. Spinal fusions are the most expensive hospital-based procedure nationally, incurring more than $12 billion in annual hospital costs alone. Accordingly, identifying risk factors for reoperation may prevent unnecessary surgical intervention in a growing population of patients with comorbid disease. We hypothesized that serum-glycated hemoglobin is a surrogate biomarker for the risk of reoperation. METHODS: All patients undergoing decompression, fusion, instrumentation, or augmentation of the spine from 2001 to 2015 at a single tertiary care institution were eligible for inclusion. The primary outcome was the cumulative incidence of reoperation at the index surgical site. Multivariate proportional hazards regression was used to adjust for confounding demographic, comorbid, and operative covariates. RESULTS: Approximately 13 244 patients underwent surgery during the study period. The majority of interventions were conducted in the lumbosacral spine (82%). Preoperatively, the median hemoglobin A1c (HbA1c) was 6.0%, with 39% of patients meeting the criterion for prediabetes and 31% of patients meeting the criterion for diabetes mellitus. At a median of 1 month following index intervention, 2684 patients (20%) underwent reoperation. Reoperation was more common among patients with diabetes mellitus (23%) than prediabetes (19%) or normal glucose tolerance (21%) ( P = .02). Similarly, the 12-month cumulative incidence of reoperation was greater among patients with diabetes mellitus (18%) than patients with prediabetes (15%) or normal glucose tolerance (16%) ( P = .03). Thirty- and 90-day emergency department visits and readmissions were not significantly different among cohorts. After multivariate analysis, HbA1c >6.4% was identified as an independent risk factor for reoperation (hazard ratio, 1.13; 95% confidence interval, 1.02-1.29, P = .04). CONCLUSION: In the present investigation, the hazard rate of reoperation was modestly increased among patients meeting the criterion for diabetes mellitus. Patients with prediabetes were not at elevated risk compared with those with normal glucose tolerance. Preoperative medical management may mitigate the increased cost and morbidity of reoperation.