title: The impact of diabetes mellitus on patients undergoing degenerative cervical spine surgery.
abstract: METHODS
  Retrospective administrative database analysis.
  
  
  OBJECTIVE
  To determine the impact of glycemic control on perioperative complications and outcomes in patients undergoing degenerative cervical spine surgery.
  
  
  BACKGROUND
  Diabetes mellitus (DM) is a highly prevalent systemic disease that has been shown to increase morbidity and mortality after spine surgery. Few studies have demonstrated negative effects on patients with DM who undergo cervical spine procedures; however, whether glycemic control influences surgical outcome is still unknown.
  
  
  METHODS
  The Nationwide Inpatient Sample was queried from 2002 to 2011. Patients who underwent cervical spine surgery for degenerative conditions were identified using the International Classification of Diseases Ninth Revision, Clinical Modification, codes. Three surgical cohorts were chosen: controlled diabetic, uncontrolled diabetic, and patients without diabetes. Patient demographics, surgical procedures, perioperative complications and postoperative outcomes were assessed.
  
  
  RESULTS
  The prevalence of controlled and uncontrolled diabetic patients undergoing degenerative cervical spine surgery had been increasing significantly from 2002 to 2011. Compared with patients without diabetes, uncontrolled diabetic patients had significantly increased odds of respiratory, cardiac, and genitourinary complications. Uncontrolled diabetic patients also had significantly increased risk of pulmonary embolism and postoperative infection. Uncontrolled diabetic patients had increased risk of inpatient mortality (odds ratio = 6.39, 95% confidence interval = 4.09-10.00, P < 0.0001) and increased mean length of stay (almost 5 d) compared with nondiabetic patients. Similarly, controlled diabetic patients increased the odds of perioperative complications; however not nearly to the same degree. Controlled diabetic patients extended the mean length of stay by almost a day (P < 0.0001) and significantly increased costs compared with nondiabetic patients.
  
  
  CONCLUSIONS
  Poor glycemic control increases the odds of inpatient mortality and perioperative complications in patients undergoing degenerative cervical spine surgery. Controlling DM before degenerative cervical spine surgery may lead to better outcomes and decreased costs.
  
  
  METHODS
  Therapeutic Level 3.
authors.affiliation: From the Departments of *Orthopaedic Surgery and †Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Javier Z
authors.initials: JZ
authors.lastname: Guzman
authors.forename: Branko
authors.initials: B
authors.lastname: Skovrlj
authors.forename: John
authors.initials: J
authors.lastname: Shin
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hecht
authors.forename: Sheeraz A
authors.initials: SA
authors.lastname: Qureshi
authors.forename: James C
authors.initials: JC
authors.lastname: Iatridis
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D003920:Diabetes Mellitus / Q000601:surgery*; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult