PMID- 36210491
OWN - NLM
STAT- MEDLINE
DCOM- 20230627
LR  - 20230831
IS  - 2380-0194 (Electronic)
IS  - 2380-0186 (Linking)
VI  - 36
IP  - 6
DP  - 2023 Jul 1
TI  - The Ideal Threshold of Hemoglobin A1C in Diabetic Patients Undergoing Elective 
      Lumbar Decompression Surgery.
PG  - E226-E233
LID - 10.1097/BSD.0000000000001399 [doi]
AB  - STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate the association 
      of Hemoglobin A1C (HbA1c) with surgical site infection (SSI) and patient-reported 
      outcomes (PROs), and to identify optimal HbA1c thresholds to minimize the risk of 
      SSI and maximize PROs. SUMMARY OF BACKGROUND DATA: Diabetes mellitus has been 
      associated with worsened outcomes following spine surgery. HbA1c, a surrogate of 
      glycemic control, is an important assessment tool in diabetic patients. METHODS: 
      A single-center, retrospective cohort study using prospectively collected data 
      was undertaken. Diabetic patients undergoing elective lumbar decompression 
      surgery between October 2010 and May 2021 were included. HbA1c, demographics, 
      comorbidities, and perioperative data were collected. Primary outcomes included: 
      1) SSI, and 2) PROs, including the Numeric Rating Scale (NRS)-back/leg pain and 
      Oswestry Disability Index (ODI). Secondary outcomes included: complications, 
      readmissions, and reoperations within 90-days postoperatively. The minimum 
      clinically important difference (MCID) was set at a 30% improvement from baseline 
      PROs. RESULTS: Of 1819 patients who underwent lumbar decompression surgery, 368 
      patients had diabetes mellitus, and 177 had a documented preoperative HbA1c 
      value. Of patients with available HbA1c values, the mean age was 62.5+/-12.3, the 
      mean HbA1c value was 7.2+/-1.5%, and SSI occurred in 3 (1.7%) patients only, which 
      prevented further analysis of SSI and HbA1c. A significant association was seen 
      with a higher HbA1c and failure to achieve NRS-Back pain MCID30 [Odds 
      ratio(OR)=0.53, 95% confidence interval(CI) 0.42-0.78; P =0.001] and ODI MCID30 
      (OR=0.58, 95%CI 0.44-0.77; P =0.001), but not NRS-Leg pain MCID30 (OR=1.29, 95%CI 
      0.86-1.93; P =0.208). ROC-curve analysis and Youden's index revealed an HbA1c 
      threshold of 7.8 for NRS-Back pain MCID30 (AUC=0.65, P <0.001) and 7.5 for ODI 
      MCID30 (AUC=0.65, P =0.001). CONCLUSIONS: In diabetic patients undergoing 
      elective lumbar decompression surgery, HbA1c levels above 7.8 and 7.5 were 
      associated with less improvement of NRS-Back and ODI scores at 12-months 
      postoperatively, respectively. To optimize PROs, We recommend a preoperative 
      HbA1c of 7.5 or below for diabetic patients undergoing elective lumbar 
      decompression surgery.
CI  - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Gupta, Rishabh
AU  - Gupta R
AD  - Department of Neurological Surgery.
AD  - Department of Orthopedic Surgery.
FAU - Chanbour, Hani
AU  - Chanbour H
AD  - Department of Neurological Surgery.
FAU - Roth, Steven G
AU  - Roth SG
AD  - Department of Neurological Surgery.
FAU - O'Brien, Alex
AU  - O'Brien A
AD  - Department of Orthopedic Surgery.
AD  - Center for Musculoskeletal Research, Vanderbilt University Medical Center, 
      Nashville, TN.
FAU - Davidson, Claudia
AU  - Davidson C
AD  - Department of Orthopedic Surgery.
FAU - Devin, Clinton J
AU  - Devin CJ
AD  - Steamboat Orthopedics, Steamboat Springs, CO.
FAU - Stephens, Byron F
AU  - Stephens BF
AD  - Department of Neurological Surgery.
AD  - Department of Orthopedic Surgery.
FAU - Abtahi, Amir M
AU  - Abtahi AM
AD  - Department of Neurological Surgery.
AD  - Department of Orthopedic Surgery.
FAU - Zuckerman, Scott L
AU  - Zuckerman SL
AD  - Department of Neurological Surgery.
AD  - Department of Orthopedic Surgery.
LA  - eng
PT  - Journal Article
DEP - 20221010
PL  - United States
TA  - Clin Spine Surg
JT  - Clinical spine surgery
JID - 101675083
RN  - 0 (Glycated Hemoglobin)
SB  - IM
MH  - Humans
MH  - Middle Aged
MH  - Aged
MH  - Glycated Hemoglobin
MH  - Treatment Outcome
MH  - Retrospective Studies
MH  - *Back Pain/surgery
MH  - Surgical Wound Infection
MH  - *Diabetes Mellitus
MH  - Decompression
MH  - Lumbar Vertebrae/surgery
COIS- B.F.S. II, MD has received consulting fees from Depuy-Synthes and Stryker Spine. 
      The remaining authors declare no conflicts of interest.
EDAT- 2022/10/11 06:00
MHDA- 2023/06/27 06:42
CRDT- 2022/10/10 00:02
PHST- 2021/12/29 00:00 [received]
PHST- 2022/08/17 00:00 [accepted]
PHST- 2023/06/27 06:42 [medline]
PHST- 2022/10/11 06:00 [pubmed]
PHST- 2022/10/10 00:02 [entrez]
AID - 01933606-202307000-00006 [pii]
AID - 10.1097/BSD.0000000000001399 [doi]
PST - ppublish
SO  - Clin Spine Surg. 2023 Jul 1;36(6):E226-E233. doi: 10.1097/BSD.0000000000001399. 
      Epub 2022 Oct 10.