PMID- 38240564
OWN - NLM
STAT- Publisher
LR  - 20240119
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
DP  - 2024 Jan 19
TI  - Does Tighter Glycemic Control Beyond Hemoglobin A1c of 8% Improve Outcome for 
      Lumbar Spine Surgery? A MSSIC Study.
LID - 10.1227/neu.0000000000002838 [doi]
AB  - BACKGROUND AND OBJECTIVES: Diabetes mellitus is associated with increased risk of 
      postoperative adverse outcomes. Previous studies have emphasized the role of 
      glycemic control in postoperative complications. This study aims to ascertain 
      whether controlling hemoglobin A1c (HbA1c) lower than 8% preoperatively results 
      in meaningful risk reduction or improved outcomes. METHODS: We used patient-level 
      data from the Michigan Spine Surgery Improvement Collaborative registry, focusing 
      on patients who underwent elective lumbar spine surgery between 2018 and 2021. 
      The primary outcomes were length of stay and the occurrence of postoperative 
      adverse events. Secondary outcomes included patient satisfaction, achievement of 
      a minimum clinically important difference (MCID) of Patient-Reported Outcomes 
      Measurement Information System-Physical Function, the EuroQol-5D and NRS of leg 
      and back pain, and return to work. RESULTS: A total of 11 348 patients were 
      included in this analysis. Patients with HbA1c above the thresholds before 
      surgery had significantly higher risks of urinary retention for all 3 possible 
      threshold values (incidence rate ratio [IRR] = 1.30, P = .015; IRR = 1.35, P = 
      .001; IRR = 1.25, P = .011 for the HbA1c cutoffs of 8%, 7.5%, and 7%, 
      respectively). They also had longer hospital stay (IRR = 1.04, P = .002; IRR = 
      1.03, P = .001; IRR = 1.03, P < .001 for the HbA1c cutoffs of 8%, 7.5%, and 7%, 
      respectively) and had higher risks of developing any complication with HbA1c 
      cutoff of 7.5% (IRR = 1.09, P = .010) and 7% (IRR = 1.12, P = .001). Diabetics 
      with preoperative HbA1c above all 3 thresholds were less likely to achieve 
      Patient-Reported Outcomes Measurement Information System MCID at the 90-day 
      follow-up (IRR = .81, P < .001; IRR = .86, P < .001; IRR = .90, P = .007 for the 
      HbA1c cutoffs of 8%, 7.5%, and 7%, respectively) and less likely to achieve 
      EuroQol-5D MCID at the 2-year follow-up (IRR = .87, P = .027; IRR = .84, P = .005 
      for the HbA1c cutoffs of 7.5% and 7%, respectively). CONCLUSION: Our study 
      suggests that reducing HbA1c below 8% may have diminishing returns regarding 
      reducing complications after spine surgery.
CI  - Copyright (c) Congress of Neurological Surgeons 2024. All rights reserved.
FAU - Telemi, Edvin
AU  - Telemi E
AD  - Department of Neurosurgery, Center for Health Services Research, Henry Ford 
      Health, Detroit, Michigan, USA.
FAU - Mansour, Tarek R
AU  - Mansour TR
AD  - Department of Neurosurgery, Center for Health Services Research, Henry Ford 
      Health, Detroit, Michigan, USA.
FAU - Brennan, Matthew
AU  - Brennan M
AD  - Wayne State University - School of Medicine, Detroit, Michigan, USA.
FAU - Simo, Leticia
AU  - Simo L
AD  - Wayne State University - School of Medicine, Detroit, Michigan, USA.
FAU - Hu, Jianhui
AU  - Hu J
AD  - Department of Public Health Sciences, Center for Health Services Research, Henry 
      Ford Health, Detroit, Michigan, USA.
FAU - Schultz, Lonni
AU  - Schultz L
AD  - Department of Public Health Sciences, Center for Health Services Research, Henry 
      Ford Health, Detroit, Michigan, USA.
FAU - Nerenz, David R
AU  - Nerenz DR
AD  - Department of Public Health Sciences, Center for Health Services Research, Henry 
      Ford Health, Detroit, Michigan, USA.
FAU - Khalil, Jad G
AU  - Khalil JG
AD  - Department of Orthopedics, Beaumont Royal Oak Hospital, Royal Oak, Michigan, USA.
FAU - Easton, Richard
AU  - Easton R
AD  - Department of Orthopedics, Beaumont Troy Hospital, Troy, Michigan, USA.
FAU - Perez-Cruet, Miguelangelo
AU  - Perez-Cruet M
AD  - Department of Neurosurgery, Beaumont Royal Oak Hospital, Royal Oak, Michigan, 
      USA.
FAU - Aleem, Ilyas
AU  - Aleem I
AD  - Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Park, Paul
AU  - Park P
AD  - Department of Neurosurgery, University of Tennessee - Semmes Murphey, Memphis, 
      Tennessee, USA.
FAU - Soo, Teck
AU  - Soo T
AD  - Division of Neurosurgery, Ascension Providence Hospital, College of Human 
      Medicine, Michigan State University, Southfield, Michigan, USA.
FAU - Tong, Doris
AU  - Tong D
AD  - Division of Neurosurgery, Ascension Providence Hospital, College of Human 
      Medicine, Michigan State University, Southfield, Michigan, USA.
FAU - Abdulhak, Muwaffak
AU  - Abdulhak M
AD  - Department of Neurosurgery, Center for Health Services Research, Henry Ford 
      Health, Detroit, Michigan, USA.
FAU - Schwalb, Jason M
AU  - Schwalb JM
AD  - Department of Neurosurgery, Center for Health Services Research, Henry Ford 
      Health, Detroit, Michigan, USA.
FAU - Chang, Victor
AU  - Chang V
AUID- ORCID: 0000-0002-8580-0706
AD  - Department of Neurosurgery, Center for Health Services Research, Henry Ford 
      Health, Detroit, Michigan, USA.
LA  - eng
PT  - Journal Article
DEP - 20240119
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
EDAT- 2024/01/19 12:43
MHDA- 2024/01/19 12:43
CRDT- 2024/01/19 09:03
PHST- 2023/07/25 00:00 [received]
PHST- 2023/11/24 00:00 [accepted]
PHST- 2024/01/19 12:43 [medline]
PHST- 2024/01/19 12:43 [pubmed]
PHST- 2024/01/19 09:03 [entrez]
AID - 00006123-990000000-01025 [pii]
AID - 10.1227/neu.0000000000002838 [doi]
PST - aheadofprint
SO  - Neurosurgery. 2024 Jan 19. doi: 10.1227/neu.0000000000002838.