Association of Elevated Perioperative Blood Glucose With Complications and Postoperative Outcomes Following Traumatic Spine Surgery

Overview

Journal Int J Spine Surg

Date 2024 Aug 12

PMID 39134410

Authors

Yianni Bakaes

Michael Spitnale

Chase Gauthier

Justin E Kung

David Edelman

Richard Bidwell

Michel Shahid

Gregory Grabowski

Affiliations

Soon will be listed here.

Abstract

Background: Perioperative blood glucose control has been demonstrated to influence outcomes following spine surgery, though this association has not been fully elucidated in patients with traumatic spine injuries. This study sought to determine the association between perioperative blood glucose levels and complications or outcomes in patients undergoing spine surgery due to injury.

Methods: A retrospective review was conducted to identify patients who underwent spine surgery due to traumatic injuries between 1 March 2020 and 29 September 2022 at a single academic institution. Descriptive factors, complications, and outcomes were compared between those with a postoperative blood glucose level of <200 mg/dL and those with a preoperative glucose of <200 mg/dL.

Results: Patients with a post- and preoperative blood glucose of ≥200 mg/dL had significantly higher odds of respiratory complications (OR = 2.1, 2.1, = 0.02, 0.03), skin/wound complications (OR = 2.2, 2.8, = 0.04, 0.03), and increased hospital length of stay (OR = 9.6, 12.1, = 0.02, 0.03) compared with those with blood glucose of <200 mg/dL. Those with postoperative glucose ≥200 mg/dL also had significantly higher odds of inpatient mortality (OR = 4.5, = 0.04) when controlling for confounding factors. Neither pre- nor postoperative blood glucose of ≥200 mg/dL was associated with an improvement in American Spinal Injury Association Impairment Scale score at the final follow-up when controlling for multiple confounding factors ( = 0.44, 0.06).

Conclusion: Elevated blood glucose both pre- and postoperatively was associated with an increased rate of postoperative complications and negative postoperative outcomes. However, there was no association between elevated blood glucose levels and neurological recovery following traumatic spinal injury.

Level Of Evidence: 3:

Citing Articles

Predicting Surgical Site Infections in Spine Surgery: Association of Postoperative Lymphocyte Reduction.

Miyamoto A, Tanaka M, Flores A, Yu D, Jain M, Heng C Diagnostics (Basel). 2024; 14(23).

PMID: 39682623 PMC: 11640511. DOI: 10.3390/diagnostics14232715.

References

Sterner R, Brooks N . Early Decompression and Short Transport Time After Traumatic Spinal Cord Injury are Associated with Higher American Spinal Injury Association Impairment Scale Conversion. Spine (Phila Pa 1976). 2021; 47(1):59-66. DOI: 10.1097/BRS.0000000000004121. View

Guzman J, Iatridis J, Skovrlj B, Cutler H, Hecht A, Qureshi S . Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery. Spine (Phila Pa 1976). 2014; 39(19):1596-604. PMC: 4149698. DOI: 10.1097/BRS.0000000000000482. View

Ahuja C, Wilson J, Nori S, Kotter M, Druschel C, Curt A . Traumatic spinal cord injury. Nat Rev Dis Primers. 2017; 3:17018. DOI: 10.1038/nrdp.2017.18. View

van Middendorp J, Hosman A, Donders A, Pouw M, Ditunno Jr J, Curt A . A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet. 2011; 377(9770):1004-10. DOI: 10.1016/S0140-6736(10)62276-3. View

Xing D, Ma J, Ma X, Song D, Wang J, Chen Y . A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J. 2012; 22(3):605-15. PMC: 3585628. DOI: 10.1007/s00586-012-2514-6. View

Bracken M . Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2012; 1:CD001046. PMC: 6513405. DOI: 10.1002/14651858.CD001046.pub2. View

DeVivo M . Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012; 50(5):365-72. DOI: 10.1038/sc.2011.178. View

Hurlbert R, Hadley M, Walters B, Aarabi B, Dhall S, Gelb D . Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2015; 76 Suppl 1:S71-83. DOI: 10.1227/01.neu.0000462080.04196.f7. View

Peng W, Liang Y, Lu T, Li M, Li D, Du K . Multivariate analysis of incision infection after posterior lumbar surgery in diabetic patients: A single-center retrospective analysis. Medicine (Baltimore). 2019; 98(23):e15935. PMC: 6571281. DOI: 10.1097/MD.0000000000015935. View

10.

Hawkins B, Lundeen T, Norwood K, Brooks H, Egleton R . Increased blood-brain barrier permeability and altered tight junctions in experimental diabetes in the rat: contribution of hyperglycaemia and matrix metalloproteinases. Diabetologia. 2006; 50(1):202-11. DOI: 10.1007/s00125-006-0485-z. View

11.

Kirshblum S, Waring 3rd W . Updates for the International Standards for Neurological Classification of Spinal Cord Injury. Phys Med Rehabil Clin N Am. 2014; 25(3):505-17, vii. DOI: 10.1016/j.pmr.2014.04.001. View

12.

Khan J, Michalski J, Basques B, Louie P, Chen O, Hayani Z . Do Clinical Outcomes and Sagittal Parameters Differ Between Diabetics and Nondiabetics for Degenerative Spondylolisthesis Undergoing Lumbar Fusion?. Global Spine J. 2020; 10(3):286-293. PMC: 7160811. DOI: 10.1177/2192568219850090. View

13.

Tanishima S, Mihara T, Tanida A, Takeda C, Murata M, Takahashi T . Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study. Asian Spine J. 2018; 13(3):468-477. PMC: 6547393. DOI: 10.31616/asj.2018.0082. View

14.

Wilson J, Forgione N, Fehlings M . Emerging therapies for acute traumatic spinal cord injury. CMAJ. 2012; 185(6):485-92. PMC: 3612151. DOI: 10.1503/cmaj.121206. View

15.

Dokai T, Nagashima H, Nanjo Y, Tanida A, Teshima R . Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients. Arch Orthop Trauma Surg. 2011; 132(5):577-82. DOI: 10.1007/s00402-011-1449-4. View

16.

Furlan J . Effects on Outcomes of Hyperglycemia in the Hyperacute Stage after Acute Traumatic Spinal Cord Injury. Neurotrauma Rep. 2021; 2(1):14-24. PMC: 8240828. DOI: 10.1089/neur.2020.0042. View

17.

Najafali D, Pozin M, Naik A, MacInnis B, Subbarao N, Zuckerman S . Early Predictors and Outcomes of American Spinal Injury Association Conversion at Discharge in Surgical and Nonsurgical Management of Sports-Related Spinal Cord Injury. World Neurosurg. 2022; 171:e93-e107. DOI: 10.1016/j.wneu.2022.11.084. View

18.

Langlois J, Bouyer B, Larroque B, Dauzac C, Guigui P . Glycemic instability of non-diabetic patients after spine surgery: a prospective cohort study. Eur Spine J. 2014; 23(11):2455-61. DOI: 10.1007/s00586-014-3489-2. View

19.

Worley N, Buza J, Jalai C, Poorman G, Day L, Vira S . Diabetes as an Independent Predictor for Extended Length of Hospital Stay and Increased Adverse Post-Operative Events in Patients Treated Surgically for Cervical Spondylotic Myelopathy. Int J Spine Surg. 2017; 11:10. PMC: 5537976. DOI: 10.14444/4010. View

20.

van Middendorp J, Hosman A, Pouw M, van de Meent H . ASIA impairment scale conversion in traumatic SCI: is it related with the ability to walk? A descriptive comparison with functional ambulation outcome measures in 273 patients. Spinal Cord. 2008; 47(7):555-60. DOI: 10.1038/sc.2008.162. View