1557. Effect of Diabetes on Postoperative Outcomes Following Posterior Cervical Decompression and Fusion

Authors: Sean Neifert; Annie Arrighi-Allisan, BS; Jeffrey Zimering, MD; Jonathan Gal, MD; Brian Deutsch, BS; Daniel Snyder, BS; John Caridi, MD (New York, NY)

Introduction : Posterior cervical decompression and fusion (PCDF) is used to correct a variety of cervical spine pathologies; however, studies examining diabetes mellitus (DM) as a predictor of postoperative complications in spine surgery are equivocal. The present study compares patients with and without DM on the basis of demographics and complication rates following PCDF. Methods : Demographic and perioperative information for all patients undergoing PCDF at a single institution from 2008-2016 was queried. Patients undergoing concurrent anterior cervical surgery were excluded. Patients with and without a diagnosis of diabetes were compared using chi-square, Student’s t-test, and multivariable regression modeling. Results : Patients with diabetes were significantly sicker (82.09% of patients had ASA Class >2 vs. 46.35%, P <0.0001), older (62.81 vs. 57.44 years, P <0.0001), and possessed a greater number of preoperative comorbidities (24.88% of patients had Elixhauser score >0 vs. 17.21%, P =0.02) than patients without diabetes. Patients with diabetes were not significantly more likely than non-diabetic patients to experience a severe postoperative complication. Those with diabetes were significantly more likely to experience an ICU stay (26.87% vs. 15.85%, P =0.0002), nonhome discharge (40.70% vs. 26.89%, P <0.0001), and a prolonged length of stay (43.28% vs. 27.95%, P<0.0001) than were non-diabetic patients. Cost modeling demonstrated that PCDF for diabetic patients was associated with a $4,533 increase in costs (95% CI: $2,228-$6,838, P <0.0001); however, this discrepancy in costs did not persist when controlling for comorbidity burden. Conclusions : The present study demonstrates a correlation between diabetes and prolonged length of stay, ICU stay, and nonhome discharge following PCDF. Future research should work to identify the precise comorbidity factors contributing to these discrepancies in outcomes and cost.