Preoperative HbA1c>8% Is Associated With Poor Outcomes in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative Study.

Abstract

Preoperative hemoglobin A1c (HbA1c) is a useful screening tool since a significant portion of diabetic patients in the United States are undiagnosed and the prevalence of diabetes continues to increase. However, there is a paucity of literature analyzing comprehensive association between HbA1c and postoperative outcome in lumbar spine surgery. To assess the prognostic value of preoperative HbA1c>8% in patients undergoing elective lumbar spine surgery. The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried to track all elective lumbar spine surgeries between January 2018 and December 2019. Cases were divided into 2 cohorts based on preoperative HbA1c level (≤8% and>8%). Measured outcomes include any complication, surgical site infection (SSI), readmission (RA) within 30 d (30RA) and 90 d (90RA) of index operation, patient satisfaction, and the percentage of patients who achieved minimum clinically important difference (MCID) using Patient-Reported Outcomes Measurement Information System. We captured 4778 patients in this study. Our multivariate analysis demonstrated that patients with HbA1c>8% were more likely to experience postoperative complication (odds ratio [OR] 1.81, 95% CI 1.20-2.73; P=.005) and be readmitted within 90 d of index surgery (OR 1.66, 95% CI 1.08-2.54; P=.021). They also had longer hospital stay (OR 1.12, 95% CI 1.03-1.23; P=.009) and were less likely to achieve functional improvement after surgery (OR 0.64, 95% CI 0.44-0.92; P=.016). HbA1c>8% is a reliable predictor of poor outcome in elective lumbar spine surgery. Clinicians should consider specialty consultation to optimize patients' glycemic control prior to surgery.