title: The relationship between diabetes and the reoperation rate after lumbar spinal surgery: a nationwide cohort study.
abstract: BACKGROUND
  Diabetes is present in 5% to 20% of patients undergoing spine surgeries and is a known risk factor for reoperation. Considering the chronicity of diabetes, its influence on the reoperation rate may differ over time.
  
  
  OBJECTIVE
  To present the relationship between diabetes and the reoperation rate over time.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A national health insurance database was used to identify a cohort of patients who underwent an initial surgery for lumbar degenerative disease in 2003 (n=34,918).
  
  
  METHODS
  The primary end point was any type of second lumbar surgery after fusion surgery (n=4,792) or decompression surgery (n=30,126) during the early (0-postoperative 90 days), short-term (91-365 days), and midterm (1-6 years) periods.
  
  
  METHODS
  All patients were followed up until December 2008. Cox proportional hazards regression modeling was used to assess the adjusted reoperation rates in the diabetic patients.
  
  
  RESULTS
  The incidence of diabetes in the present cohort was 24.5% in the fusion group and 16.9% in the decompression group. Overall, reoperation was performed in 13.2% (631 of 4,792) of the patients after fusion surgery and in 14.0% (4,214 of 30,126) of the patients after decompression surgery. After fusion surgery, diabetes did not make a significant difference in the reoperation rate during the entire follow-up period. After decompression surgery, the reoperation rate was not different during Postoperative Month 3, but diabetic patients showed a 1.2 to 1.4 times higher reoperation rate during postoperative 3 months to 5 years (p<.01).
  
  
  CONCLUSIONS
  The study did not find a relationship between diabetes at the time of surgery and the reoperation rate during the early postoperative period. Thereafter, the reoperation rate was not higher after fusion surgery in diabetic patients, but it was higher after decompression surgery.
authors: Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea; Neuroscience and Clinical Research Institute, Seoul National University Hospital, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea.
authors: Chi Heon
authors: CH
authors: Kim
authors: Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea; Neuroscience and Clinical Research Institute, Seoul National University Hospital, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea. Electronic address: chungc@snu.ac.kr.
authors: Chun Kee
authors: CK
authors: Chung
authors: Health Insurance Review and Assessment Service, 267 Hyoyeoung-ro, Seocho-gu, Seoul 137-706, Korea.
authors: Sukyoun
authors: S
authors: Shin
authors: Health Insurance Review and Assessment Service, 267 Hyoyeoung-ro, Seocho-gu, Seoul 137-706, Korea; Department of Nursing, Kyungdong University, 95, Cheongdamro, Yangju, Gyeonggido 482-010, Korea.
authors: Bo Ram
authors: BR
authors: Choi
authors: Medical Research Collaborating Center, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea.
authors: Min Jung
authors: MJ
authors: Kim
authors: Medical Research Collaborating Center, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea; Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea.
authors: Byung Joo
authors: BJ
authors: Park
authors: Medical Research Collaborating Center, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Korea.
authors: Yunhee
authors: Y
authors: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D014481:United States
keywords: Decompression; Diabetes; Fusion; Lumbar spine; Reoperation rate; Spine; Surgery