Diabetes and perioperative outcomes following cervical fusion in patients with myelopathy

Study Design. Database study using the Nationwide Inpatient Sample administrative data from 1988 through 2004. Objective. To examine perioperative morbidity and mortality for patients diagnosed with myelopathy, with and without diabetes mellitus (DM) (and subclassifications) following cervical spinal fusion. Summary of Background Data. DM has been associated with worse outcomes in a variety of orthopedic procedures including spinal surgery. Evidence that patients with DM have more complications following cervical fusion, specifically those treated for myelopathy, has been suggested within the literature but has been poorly explored. Methods. Data from 37,732 patients within Nationwide Inpatient Sample database (1988-2004) with diagnostic codes specifying the presence of myelopathy and who underwent cervical fusion were included in the analysis. Patients were compared on the basis of the presence of DM, type of DM, and whether DM was controlled or uncontrolled. Bivariate statistical analyses compared postoperative complication rates while multivariate statistics were used to determine likelihood of complications with DM. Results. Multivariate regression modeling outlined higher likelihoods of complications and hospital discharge variables with DM, particularly if it was diagnosed as uncontrolled disease. Fewer significant discrepancies in complications were noted in comparison of Type I versus Type II DM. Conclusion. This nationally representative study of inpatients in the United States provides evidence that patients with DM who received cervical fusion secondary to myelopathy are associated with greater perioperative complications, nonroutine discharge, and increased total charges. Subanalyses suggest that uncontrolled DM is a significant associative factor in outcome.