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

Authors

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

Document Type

Article

Publication Date

10-13-2021

Publication Title

Neurosurgery

Abstract

BACKGROUND: Preoperative hemoglobin A1c (HbA1c) is a useful screening tool since a significant portion of diabetic patients in the United States are undiagnosed and the prevalence of diabetes continues to increase. However, there is a paucity of literature analyzing comprehensive association between HbA1c and postoperative outcome in lumbar spine surgery.

OBJECTIVE: To assess the prognostic value of preoperative HbA1c > 8% in patients undergoing elective lumbar spine surgery.

METHODS: The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried to track all elective lumbar spine surgeries between January 2018 and December 2019. Cases were divided into 2 cohorts based on preoperative HbA1c level (≤8% and >8%). Measured outcomes include any complication, surgical site infection (SSI), readmission (RA) within 30 d (30RA) and 90 d (90RA) of index operation, patient satisfaction, and the percentage of patients who achieved minimum clinically important difference (MCID) using Patient-Reported Outcomes Measurement Information System.

RESULTS: We captured 4778 patients in this study. Our multivariate analysis demonstrated that patients with HbA1c > 8% were more likely to experience postoperative complication (odds ratio [OR] 1.81, 95% CI 1.20-2.73; P = .005) and be readmitted within 90 d of index surgery (OR 1.66, 95% CI 1.08-2.54; P = .021). They also had longer hospital stay (OR 1.12, 95% CI 1.03-1.23; P = .009) and were less likely to achieve functional improvement after surgery (OR 0.64, 95% CI 0.44-0.92; P = .016).

CONCLUSION: HbA1c > 8% is a reliable predictor of poor outcome in elective lumbar spine surgery. Clinicians should consider specialty consultation to optimize patients' glycemic control prior to surgery.

Volume

89

Issue

5

First Page

819

Last Page

826

Recommended Citation

Lim S, Yeh HH, Macki M, Mansour T, Schultz L, Telemi E, Haider S, Nerenz DR, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil J, Perez-Cruet M, Chang V. Preoperative HbA1c > 8% Is Associated With Poor Outcomes in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative Study. Neurosurgery. 2021 Oct 13;89(5):819-826. doi: 10.1093/neuros/nyab294. PMID: 34352887.

DOI

10.1093/neuros/nyab294

ISSN

1524-4040

PubMed ID

34352887