Diabetes and complications of spinal surgery: a meta-analysis of comparative or controlled studies

doi:10.3969/j.issn.2095-4344.2015.53.022

Abstract

Abstract:

BACKGROUND: Currently, discectomy, fusion or decompression is considered an effective and conventional method for the treatment of spinal disease. Although there have been many reports on the adverse effects of diabetes on spinal surgery, but there are still some differences.
OBJECTIVE: To systematically evaluate the observational studies and case-control studies about the effect of diabetes on the complications of spinal surgery.
METHODS: The controlled and comparative studies regarding the effect of diabetes on the results and complications of spinal surgery were searched from the database according to the inclusion criteria. The observed indicators including mortality, revision rate, surgical site infection, the incidence of venous thrombosis, blood loss, operative time and hospitalization time. Two authors participated in extracting the data and evaluating the methodology and quality of the included studies. Meta-analysis was conducted according to the guidelines of epidemiological observational studies (MOOSE). The risk assessment of the extracted data was conducted using RevMan 5.2 software.
RESULTS AND CONCLUSION: Eighteen literatures, involving 2 824 063 patients, were eventually enrolled. The
experimental result showed that the mortality, surgical site infection, incidence of venous thrombosis of diabetic patients after the spinal surgery were significantly higher than those of non-diabetic patients; the hospital stay was significantly longer than that of non-diabetic patients (P < 0.05). There were no significant differences in the risk of revision, intraoperative blood loss and operation time between diabetic patients and non-diabetic patients (P > 0.05). These results suggest that diabetic patients take a higher risk once accepting the spinal surgery than the non-diabetic patients. Diabetes increases the risks of postoperative mortality, surgical site infection, venous thrombosis and hospitalization time after spinal surgery.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

CLC Number:

R318

Lin Qiao, Li Zhao-wei, Qian Xuan-kun, Jiang Jin, Wang Jian-min. Diabetes and complications of spinal surgery: a meta-analysis of comparative or controlled studies[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(53): 8685-8692.

Figures/Tables 6

References

[1] Bailes BK. Diabetes mellitus and its chronic complications. AORN J. 2002; 76(2): 266-276, 278-282; quiz 283-286.

[2] Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diab Res Clin Prac. 2010; 87(1): 4-14.

[3] Ortega E, Amor AJ, Rojo-Martinez G, et al. [Cardiovascular disease in patients with type 1 and type 2 diabetes in Spain.]. Med Clin (Barc). 2015.

[4] Kan F, Fang F, Tian H, et al. [Mortality risks of type 2 diabetes mellitus among elderly patients: a 17-year cohort study]. Zhonghua Yi Xue Za Zhi. 2014; 94(33): 2597-2601.

[5] Rizvi AA, Chillag SA, Chillag KJ. Perioperative management of diabetes and hyperglycemia in patients undergoing orthopaedic surgery. J Am Acad Orthop Surg. 2010; 18(7): 426-435.

[6] Tsang ST, Gaston P. Adverse peri-operative outcomes following elective total hip replacement in diabetes mellitus: a systematic review and meta-analysis of cohort studies. Bone Joint J. 2013; 95-B(11): 1474-1479.

[7] Yang Z, Liu H, Xie X, et al. The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. Bone Joint J. 2014; 96-B(12): 1637-1643.

[8] Cohen SP, Larkin T, Abdi S, et al. Risk factors for failure and complications of intradiscal electrothermal therapy: a pilot study. Spine. 2003; 28(11): 1142-1147.

[9] Glassman SD, Alegre G, Carreon L, et al. Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus. Spine J. 2003; 3(6): 496-501.

[10] Cook C, Tackett S, Shah A, et al. Diabetes and perioperative outcomes following cervical fusion in patients with myelopathy. Spine. 2008; 33(8): E254-260.

[11] Browne JA, Cook C, Pietrobon R, et al. Diabetes and early postoperative outcomes following lumbar fusion. Spine. 2007; 32(20): 2214-2219.

[12] Kawaguchi Y, Matsui H, Ishihara H, et al. Surgical outcome of cervical expansive laminoplasty in patients with diabetes mellitus. Spine. 2000; 25(5): 551-555.

[13] Pullter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine. 2009; 34(13): 1422-1428.

[14] Hikata T, Iwanami A, Hosogane N, et al. High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. J Orthop Sci. 2014; 19(2): 223-228.

[15] Appaduray SP, Lo P. Effects of diabetes and smoking on lumbar spinal surgery outcomes. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2013; 20(12): 1713-1717.

[16] Arnold PM, Fehlings MG, Kopjar B, et al. Mild diabetes is not a contraindication for surgical decompression in cervical spondylotic myelopathy: results of the AOSpine North America multicenter prospective study (CSM). Spine J. 2014; 14(1): 65-72.

[17] Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000; 283(15): 2008-2012.

[18] Wells GA, Shea BO, Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. February 10, 2015 [cited; Available from: http://www.ohri.ca/Programs/clinical_epidemiology/ oxford.as

[19] Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004; 328(7454): 1490.

[20] Golinvaux NS, Varthi AG, Bohl DD, et al. Complication rates following elective lumbar fusion in patients with diabetes: insulin dependence makes the difference. Spine. 2014; 39(21): 1809-1816.

[21] Guzman JZ, Iatridis JC, Skovrlj B, et al. Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery. Spine. 2014; 39(19): 1596-1604.

[22] Takahashi S, Suzuki A, Toyoda H, et al. Characteristics of diabetes associated with poor improvements in clinical outcomes after lumbar spine surgery. Spine. 2013; 38(6): 516-522.

[23] Sharma A, Muir R, Johnston R, et al. Diabetes is predictive of longer hospital stay and increased rate of complications in spinal surgery in the UK. Ann R Coll Surg Engl. 2013; 95(4): 275-279.

[24] Cho W, Lenke LG, Bridwell KH, et al. Comparison of spinal deformity surgery in patients with non-insulin-dependent diabetes mellitus (NIDDM) versus controls. Spine. 2012; 37(16): E978-984.

[25] Chen S, Anderson MV, Cheng WK, et al. Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res. 2009; 467(7): 1670-1673.

[26] Liao JC, Chen WJ, Chen LH, et al. Postoperative wound infection rates after posterior instrumented spinal surgery in diabetic patients. Chang Gung Med J. 2006; 29(5): 480-485.

[27] Arinzon Z, Adunsky A, Fidelman Z, et al. Outcomes of decompression surgery for lumbar spinal stenosis in elderly diabetic patients. Eur Spine J. 2004; 13(1): 32-37.

[28] Simpson JM, Silveri CP, Balderston RA, et al. The results of operations on the lumbar spine in patients who have diabetes mellitus. J Bone Joint Surg. 1993; 75(12): 1823-1829.

[29] Machino M, Yukawa Y, Ito K, et al. Impact of diabetes on the outcomes of cervical laminoplasty: a prospective cohort study of more than 500 patients with cervical spondylotic myelopathy. Spine. 2014; 39(3): 220-227.

[30] Freedman MK, Hilibrand AS, Blood EA, et al. The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial. Spine. 2011; 36(4): 290-307.

[31] Bhutani J, Bhutani S. Worldwide burden of diabetes. Indian J Endocrinol Metab. 2014; 18(6): 868-870.

[32] Farrell C, Moran J. Comparison of comorbidities in patients with pre-diabetes to those with diabetes mellitus type 2. Ir Med J. 2014; 107(3): 72-74.

[33] Hamdan AD, Saltzberg SS, Sheahan M, et al. Lack of association of diabetes with increased postoperative mortality and cardiac morbidity: results of 6565 major vascular operations. Arch Surg. 2002; 137(4): 417-421.

[34] Carson JL, Scholz PM, Chen AY, et al. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002; 40(3): 418-423.

[35] Goodson WH, 3rd, Hung TK. Studies of wound healing in experimental diabetes mellitus. J Surg Res. 1977; 22(3): 221-227.

[36] Bagdade JD, Stewart M, Walters E. Impaired granulocyte adherence. A reversible defect in host defense in patients with poorly controlled diabetes. Diabetes. 1978; 27(6): 677-681.

[37] Twigg SM, Chen MM, Joly AH, et al. Advanced glycosylation end products up-regulate connective tissue growth factor (insulin-like growth factor-binding protein-related protein 2) in human fibroblasts: a potential mechanism for expansion of extracellular matrix in diabetes mellitus. Endocrinology. 2001; 142(5): 1760-1769.

[38] Jones EW, Mitchell JR. Venous thrombosis in diabetes mellitus. Diabetologia. 1983; 25(6): 502-505.