Influence of diabetes mellitus on patients with lumbar spinal stenosis: A nationwide population-based study.

Chang Kyu Lee,Keung Nyun Kim,Seong Yi,Insoo Kim,Sun Kyu Choi,Yoon Ha,Dong Ah Shin,Gregory W.J Hawryluk

doi:10.1371/journal.pone.0213858

Chang Kyu Lee, Keung Nyun Kim + Show 6 more

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https://doi.org/10.1371/journal.pone.0213858

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Abstract

PurposeTo evaluate the relationship between comorbidities, medical cost, and surgical outcome in patients with lumbar spinal stenosis (LSS) and diabetes mellitus (DM).MethodsData on patients with LSS (n = 14,298) were collected from the Korean National Health Insurance Service database from 2005 to 2007. After 8 years of follow-up, a “DM group” (n = 3,478) and a “non-DM group” (n = 10,820) were compared according to outcome measures. Cox proportional hazard regressions were performed to examine the relationship between DM, hypertension (HTN), cardiovascular disease (CVD), chronic kidney disease (CKD), cerebrovascular disease (CbVD), and surgery for LSS. The admission rate and medical cost as well asthe overall survival rate for those who underwent lumbar surgery were also assessed among patients with DM and LSS.ResultsMortality was about 1.35 times higher in the DM group than in the non-DM group. Patients with DM and comorbidities including HTN (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.25–1.56; p<0.001), CVD (HR, 1.53; 95% CI, 1.36–1.73; p<0.001), CKD (HR, 3.18; 95% CI, 2.7–3.76; p<0.001), and CbVD (HR, 1.69; 95% CI, 1.49–1.91; p<0.001) showed an increased risk of mortality. The mean hospitalization time and average medical cost of patients with DM who underwent lumbar surgery were 60.8 days, and 7,127 USD, respectively. This was 31.3 days longer, and 6,207 USD higher, respectively, than those of patients with DM who underwent conservative treatment for LSS. Within the DM group, the survival rate of surgical management of LSS had a significant tendency for positive prognosis compared with those administered conservative treatment (p = 0.046).ConclusionsIn patients with LSS, DM was associated both with poor prognosis (most significantly in those with CKD), and increased medical cost in those who underwent surgery. Nevertheless, surgical treatment for LSS in patients with DM was related to favorable prognosis compared with conservative treatment.

Highlights

Diabetes mellitus (DM) has become a major public health problem due to the increasing prevalence of associated morbidity and mortality [1]
Patients with DM and comorbidities including HTN, cardiovascular disease (CVD) (HR, 1.53; 95% confidence intervals (CIs), 1.36–1.73; p
Within the DM group, the survival rate of surgical management of lumbar spinal stenosis (LSS) had a significant tendency for positive prognosis compared with those administered conservative treatment (p = 0.046)

Summary

Introduction

Diabetes mellitus (DM) has become a major public health problem due to the increasing prevalence of associated morbidity and mortality [1]. The mortality rate of patients with DM is reported to be 2–3 times higher than that of the general population [2,3]. DM is associated with various chronic diseases, such as hypertension (HTN), cardiovascular disease (CVD), chronic kidney disease (CKD), and cerebrovascular disease (CbVD). DM increases the risk of heart failure and coronary heart disease [4], and the prevalence and progression rates of CKD are higher in patients with DM [5]. An increased life expectancy and a higher DM incidence lead to an increase in the number of chronic comorbid diseases [5]

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