title: Impact of Insulin Dependence on Perioperative Outcomes Following Anterior Cervical Discectomy and Fusion.
abstract: METHODS
  A retrospective analysis of prospectively collected data.
  
  
  OBJECTIVE
  Our objective was to analyze insulin-dependent and noninsulin-dependent diabetes mellitus (IDDM and NIDDM) as potential risk factors for complications, reoperations, and readmissions within 30 days following anterior cervical discectomy and fusion (ACDF).
  
  
  BACKGROUND
  ACDF is a common surgical procedure with growing utilization and good long-term outcomes. Readmissions and reoperations are associated with increased morbidity and inferior long-term outcomes. IDDM and NIDDM are often associated with increased complication rates.
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data from the ACS NSQIP database. Patients ≥18 years old undergoing ACDF from 2005 to 2012 were included. Readmission, perioperative events, and reoperation within 30 days following ACDF were measured. Patient demographics, perioperative data, preoperative labs, and postoperative events were assessed. Patients with NIDDM or IDDM were compared with nondiabetic patients using multivariate logistic regression analysis with significance defined as P < 0.05. Odds ratio (OR) was calculated with a 95% confidence interval (CI).
  
  
  RESULTS
  Three thousand seven hundred twenty-six patients were included of whom 270 were NIDDM and 171 IDDM. Readmissions and reoperation data were available only from 2011 to 2012, including 1423 nondiabetes mellitus (non-DM), 193 NIDDM, and 87 IDDM cases. NIDDM was associated with higher rates of urinary tract infection (UTI) (P < 0.007), and return to operating room (P = 0.012) than nondiabetic patients. IDDM was associated with higher rates of reoperations (P = 0.04), readmissions (P < 0.0001), and total length of stay (LOS) >5 days (P < 0.0001). Following adjusted multivariate analysis, only IDDM status remained an independent predictor for 30-day readmission (OR 4.8, 95% CI 2.3-10.1).
  
  
  CONCLUSIONS
  Patients with NIDDM and IDDM were at an increased risk for several postoperative complications following ACDF. IDDM was independently associated with increased 30-day readmission rates. Diabetic patients should be counseled appropriately, and the importance of close perioperative care is highlighted in this study.
  
  
  METHODS
  3.
authors.affiliation: NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia.|Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jun S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Parth
authors.initials: P
authors.lastname: Kothari
authors.affiliation: Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000639:trends*