263. Insulin dependence and 30-day outcomes following posterior cervical fusions: an analysis of the ACS-NSQIP database

Abstract

BACKGROUND CONTEXT Insulin dependent diabetes mellitus (IDDM) and noninsulin dependent diabetes mellitus (NIDDM) have been shown to have different postoperative outcomes. Though recent literature has evaluated the impact of different types of diabetes mellitus on 30-day outcomes following anterior cervical fusions, no study has investigated the same for posterior cervical fusions (PCFs). PURPOSE To evaluate differences in 30-day outcomes between IDDM, NIDDM and nondiabetic individuals undergoing PCFs. STUDY DESIGN/SETTING Retrospective review of prospectively collected data from a national surgical registry. PATIENT SAMPLE The 2012-2017 American College of Surgeons; National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using “Current Procedural Terminology” code 22600 to identify patients undergoing PCFs. Patients with missing data were excluded from study. Individuals undergoing PCFs due to malignancy and/or deformity were excluded. The study population was divided into three distinct cohorts 1) with IDDM, 2) with NIDDM and 3) with no diabetes mellitus. OUTCOME MEASURES The 30-day outcomes were subdivided into the following categories, 1) minor adverse events/MAE (superficial SSI, urinary tract infections, pneumonia and progressive renal insufficiency), 2) severe adverse events/SAE (deep SSI, organ/space SSI, wound dehiscence, unplanned intubation, pulmonary embolism, ventilator use >48 hours, acute renal failure, stroke, cardiac arrest, myocardial infarction, deep venous thrombosis, sepsis, septic shock, reoperation and mortality), 3) bleeding requiring transfusion, 4) readmissions and 5) any adverse event/AAE (SAE or MAE). Differences in rates of non-home discharges were also assessed between the groups. METHODS Multivariate regression analyses were used to assess differences in 30-day SAEs, MAEs, AAEs, readmissions and non-home discharges between the three groups, while controlling for baseline clinical characteristics. RESULTS A total of 2,786 PCFs were included; out of which 206 (7.4%) had IDDM, 368 (13.2%) had NIDDM and 2,212 (79.4%) did not have a diagnosis of diabetes mellitus. Following multivariate analyses, NIDDM vs no diabetes mellitus was associated with higher odds of experiencing an AAE (1.53 [95% CI 1.11-2.09]; p=0.008) and SAE (1.53 [95% CI 1.04-2.24]; p=0.030). In contrast, IDDM was associated with higher odds of a prolonged LOS (OR 1.40 [95% CI 1.01-1.93]; p=0.044), any adverse event (OR 1.51 [95% CI 1.01-2.26]; p=0.047) and non-home discharge (OR 1.50 [95% CI 1.06-2.11]; p=0.023). CONCLUSIONS Both NIDDM and IDDM are independently associated with a higher risk of experiencing adverse outcomes following PCFs, with NIDDM having a stronger effect on 30-day complications/adverse events and IDDM having higher postoperative resource utilization, as evidenced by prolonged LOS and higher rates of non-home discharges. Providers can utilize these findings for preoperative risk-stratification and patient counseling to ensure care is appropriate and individualized according to needs/requirements in the acute postoperative period. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.