title: The Association of Perioperative Glycemic Control with Deep Postoperative Infection After Anterior Cervical Discectomy and Fusion in Patients with Diabetes.
abstract: OBJECTIVE
  To evaluate the association of perioperative hemoglobin A1c(HbA1c) level in patients with diabetes with the incidence of infection after anterior cervical discectomy and fusion requiring operative intervention, in addition to determining if a threshold level of HbA1cabove which the risk of infection increases significantly exists.
  
  
  METHODS
  A national administrative database was queried for patients who underwent primary anterior cervical discectomy and fusion with diabetes who had a perioperative HbA1clevel recorded within 3 months of surgery. These patients were stratified based on their HbA1clevel in 0.5-mg/dL increments from <5.49 mg/dL to >11.5 mg/dL. The incidence of infection requiring operative intervention within 1 year was then identified using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. A receiver operating characteristic (ROC) analysis was performed to determine a threshold value of the HbA1clevel.
  
  
  RESULTS
  A total of 3341 patients with a perioperative HbA1clevel were included. The rate of deep infection requiring irrigation and debridement postoperatively stratified by HbA1clevel ranged from a low of 1.5% to a high of 6.4% and was significantly correlated with increasing HbA1clevels (P = 0.005). The results of ROC analysis determined that the inflection point of the ROC curve corresponded to an HbA1clevel higher than 7.5 mg/dL (P = 0.022; area under the curve, 0.67; specificity, 68%; sensitivity, 46%).
  
  
  CONCLUSIONS
  The risk of deep postoperative infection in patients with diabetes mellitus increases as the perioperative HbA1clevel increases. ROC analysis determined that a perioperative HbA1clevel higher than 7.5 mg/dL could serve as a threshold for a significantly increased risk of infection.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: jc2yt@virginia.edu.
authors.forename: Jourdan M
authors.initials: JM
authors.lastname: Cancienne
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Anuj
authors.initials: A
authors.lastname: Singla
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Frank H
authors.initials: FH
authors.lastname: Shen
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Shimer
mesh_terms: D001786:Blood Glucose; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D008297:Male; D009313:National Health Programs / Q000706:statistics & numerical data; D012372:ROC Curve; D012044:Regression Analysis; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: ACDF; Complication; Diabetes; HbA(1c); Infection