TY - JOUR
T1 - The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial
AU - Freedman, Mitchell K.
AU - Hilibrand, Alan S.
AU - Blood, Emily A.
AU - Zhao, Wenyan
AU - Albert, Todd J.
AU - Vaccaro, Alexander R.
AU - Oleson, Christina V.
AU - Morgan, Tamara S.
AU - Weinstein, James Neil
PY - 2011/2/15
Y1 - 2011/2/15
N2 - Study Design. A secondary analysis comparing diabetic patients with nondiabetic patients enrolled in the Spine Patient Outcomes Research Trial (SPORT). Objective. To compare surgical outcomes and complications between diabetic and nondiabetic spine patients. Summary Of Background Data. Patients with diabetes are predisposed to comorbidities that may confound the diagnosis and treatment of patients with spinal disorders. Methods. Baseline characteristics and outcomes of 199 patients with diabetes were compared with those of the nondiabetic population in a total of 2405 patients enrolled in the Spine Patient Outcomes Research Trial for the diagnoses of intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS). Primary outcome measures include the 36-Item Short Form Health Survey (SF-36) Health Status questionnaire and the Oswestry Disability Index. Results. Patients with diabetes were significantly older and had a higher body mass index than nondiabetic patients. Comorbidities, including hypertension, stroke, cardiovascular disease, and joint disease, were significantly more frequent in diabetic patients than in nondiabetic patients. Patients with diabetes and IDH did not make significant gains in pain and function with surgical intervention relative to diabetic patients who underwent nonoperative treatment. Diabetic patients with SpS and DS experienced significantly greater improvements in pain and function with surgical intervention when compared with nonoperative treatment. Among those who had surgery, nondiabetic patients with SpS achieved marginally significantly greater gains in function than their diabetic counterparts (SF-36 physical function, P = 0.062). Among patients who had surgery for DS, diabetic patients did not have as much improvement in pain or function as did the nondiabetic population (SF-36 bodily pain, P = 0.003; physical function, P = 0.002). Postoperative complications were more prevalent in patients with diabetes than in nondiabetic patients with SpS (P = 0.002). There was an increase in postoperative (P = 0.028) and intraoperative (P = 0.029) blood replacement in DS patients with diabetes. Conclusion. Diabetic patients with SpS and DS benefited from surgery, though older SpS patients with diabetes have more postoperative complications. IDH patients with diabetes did not benefit from surgical intervention.
AB - Study Design. A secondary analysis comparing diabetic patients with nondiabetic patients enrolled in the Spine Patient Outcomes Research Trial (SPORT). Objective. To compare surgical outcomes and complications between diabetic and nondiabetic spine patients. Summary Of Background Data. Patients with diabetes are predisposed to comorbidities that may confound the diagnosis and treatment of patients with spinal disorders. Methods. Baseline characteristics and outcomes of 199 patients with diabetes were compared with those of the nondiabetic population in a total of 2405 patients enrolled in the Spine Patient Outcomes Research Trial for the diagnoses of intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS). Primary outcome measures include the 36-Item Short Form Health Survey (SF-36) Health Status questionnaire and the Oswestry Disability Index. Results. Patients with diabetes were significantly older and had a higher body mass index than nondiabetic patients. Comorbidities, including hypertension, stroke, cardiovascular disease, and joint disease, were significantly more frequent in diabetic patients than in nondiabetic patients. Patients with diabetes and IDH did not make significant gains in pain and function with surgical intervention relative to diabetic patients who underwent nonoperative treatment. Diabetic patients with SpS and DS experienced significantly greater improvements in pain and function with surgical intervention when compared with nonoperative treatment. Among those who had surgery, nondiabetic patients with SpS achieved marginally significantly greater gains in function than their diabetic counterparts (SF-36 physical function, P = 0.062). Among patients who had surgery for DS, diabetic patients did not have as much improvement in pain or function as did the nondiabetic population (SF-36 bodily pain, P = 0.003; physical function, P = 0.002). Postoperative complications were more prevalent in patients with diabetes than in nondiabetic patients with SpS (P = 0.002). There was an increase in postoperative (P = 0.028) and intraoperative (P = 0.029) blood replacement in DS patients with diabetes. Conclusion. Diabetic patients with SpS and DS benefited from surgery, though older SpS patients with diabetes have more postoperative complications. IDH patients with diabetes did not benefit from surgical intervention.
KW - complications
KW - degenerative spondylolisthesis
KW - diabetes mellitus
KW - disability
KW - intervertebral disc herniation
KW - pain
KW - spinal stenosis
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U2 - 10.1097/BRS.0b013e3181ef9d8c
DO - 10.1097/BRS.0b013e3181ef9d8c
M3 - Article
C2 - 21270715
AN - SCOPUS:79951770434
VL - 36
SP - 290
EP - 307
JO - Spine
JF - Spine
SN - 0362-2436
IS - 4
ER -