110. Early experience with an Endocrinology FastTrack program for preoperative optimization of spine surgery candidates with poorly controlled diabetes mellitus

Abstract

<h3>BACKGROUND CONTEXT</h3> Previous studies have shown an increase in adverse outcomes for patients undergoing elective surgeries with poorly controlled diabetes mellitus (preoperative Hgb A1c >7). Delays in surgical treatment for symptomatic spinal stenosis and related conditions can lead to significant patient dissatisfaction, prolonged pain, disability, immobility and neurologic decline. Patients with poorly controlled diabetes often lack sufficient knowledge and the access to care required to improve their blood sugar management preoperatively. At a large, tertiary-care spine center with a significant population of poorly controlled diabetic patients, an Endocrinology FastTrack (EFT) program was developed to improve patient optimization prior to elective spine surgery. <h3>PURPOSE</h3> The purpose of the current study is to report our early experience with an Endocrinology FastTrack (EFT) program to improve blood sugar management in diabetic patients before lumbar fusion surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> Patients scheduled for elective lumbar fusion surgery witha Hgb A1c > 7 on preoperative evaluation. <h3>OUTCOME MEASURES</h3> HbA1c, surgical clearance. <h3>METHODS</h3> Seventy-five patients who had been recommended for elective spine surgery were noted to have a Hgb A1c > 7 on preoperative evaluation. Thirty-two patients accepted referral to the Endocrinology FastTrack (EFT) program and 43 declined (Non-EFT). Mean preoperative Hgb A1c was similar between groups (EFT: 8.79 vs Non-EFT:9.26, p=0.221). The FastTrack program included counseling, education and medical management. <h3>RESULTS</h3> Patients in the two groups were similar in terms of number of females (EFT: 17 vs non-EFT:17, p=0.348), age (EFT:57.7 vs non-EFT:60.6, p=0.280) and BMI (EFT:34.6 vs non-EFT:33.0, p=0.341). There was a smaller number of smokers in the EFT (1) compared to the non EFT group (15, p=0.003). The proportion of patients on insulin (EFT:19 vs non-EFT:23, p=0.814) and oral hypoglycemic (EFT:29 vs non-EFT:39, p=0.983) was similar between the two groups. Surgical clearance for patients with a documented preoperative Hgb A1c < 7 or equivalent fructosamine level was significantly better in the FastTrack group compared to the non-FastTrack group (91% vs 42%, p=0.000). While the majority of patients who declined the FastTrack did not obtain clearance for surgery, mean Hgb A1c was improved at latest follow-up in both groups who obtained surgical clearance (7.10 vs 6.78, p=0.470). <h3>CONCLUSIONS</h3> A novel Endocrinology FastTrack program was successful in obtaining acceptable blood sugar control in patients recommended for spine surgery who had poorly-controlled diabetes mellitus on preoperative evaluation. The improved blood sugar control was maintained at latest follow-up. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.