title: Complication rates following elective lumbar fusion in patients with diabetes: insulin dependence makes the difference.
abstract: METHODS
  Retrospective cohort.
  
  
  OBJECTIVE
  To determine the effect of non-insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM) on postoperative complications after elective lumbar fusion surgery.
  
  
  BACKGROUND
  Diabetes mellitus (DM) is a common chronic disease. The effects of NIDDM and IDDM on rates of postoperative complications, extended length of stay, and readmission after lumbar fusion surgery are not well established.
  
  
  METHODS
  A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients undergoing lumbar fusion between 2005 and 2012 were identified and characterized as having NIDDM, IDDM, or neither. Bivariate and multivariate analyses were used to test patients with NIDDM and IDDM for increased risk of adverse postoperative outcomes over the initial 30 postoperative days.
  
  
  RESULTS
  A total of 15,480 patients who underwent lumbar fusion were identified (13,043 were patients without DM, 1,650 patients had NIDDM, and 787 patients had IDDM).NIDDM was independently associated with an increased risk of wound dehiscence (relative risk = 2.3; P = 0.033) and extended length of stay (1.2; P < 0.003).IDDM was independently associated with an increased risk of death (2.7; P = 0.020), sepsis (2.2; P = 0.002), septic shock (3.3; P = 0.032), unplanned intubation (2.8; P = 0.003), ventilator-assisted respiration for more than 48 hours postoperatively (2.8; P = 0.005), wound-related infection (1.9; P = 0.001), urinary tract infection (1.6; P = 0.011), pneumonia (3.1; P < 0.001), extended length of stay (1.5; P < 0.001), and readmission within 30 days (1.5; P = 0.036).
  
  
  CONCLUSIONS
  Compared with patients without DM, IDDM was associated with an increased risk of a considerably higher number of postoperative complications than NIDDM. These complications were also of greater severity. This important designation may improve preoperative risk stratification and counseling of patients with diabetes prior to lumbar fusion surgery.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Golinvaux
authors.forename: Arya G
authors.initials: AG
authors.lastname: Varthi
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007902:Length of Stay; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin