Impact of Pre-diabetes on Postoperative Outcomes Following Short-segment Lumbar Fusion Surgery

Introduction: Type 2 diabetes mellitus is a well-established risk factor for adverse surgical outcomes, but the impact of pre-diabetes on spine surgery outcomes remains unexplored. This study aimed to evaluate the influence of pre-diabetes on postoperative complications in patients undergoing short-segment (≤3 levels) transforaminal lumbar interbody fusion (TLIF).

Methods: We retrospectively reviewed patients undergoing 1-3 level TLIF in a national administrative database. Patients were categorized into three groups: no diabetes, pre-diabetes, and type 2 diabetes mellitus. Patients with type 1 diabetes were excluded. Exact matching was performed to balance demographics, comorbidities, and the number of spinal levels fused across groups. Postoperative medical and surgical complications within 30-days were analyzed.

Results: A total of 17,796 patients were included after matching, with 5,932 patients in each group. Patients with DM2 demonstrated a significantly higher incidence of postoperative complications compared to those without diabetes. Specifically, the DM2 group had increased odds of urinary tract infection (odds ratio[OR], 1.49; 95% confidence interval[CI], 1.19 to 1.86), pneumonia(OR, 1.59; 95% CI, 1.10 to 2.32; p = 0.014), acute kidney injury (OR, 2.33; 95% CI, 1.71 to 3.21; p < 0.001), and surgical site infection (OR, 1.34; 95% CI, 1.04 to 1.74; p = 0.024). Additionally, patients with DM2 had higher rates of overall medical complications (OR, 1.50; 95% CI, 1.28 to 1.75; p < 0.001) and overall surgical complications(OR, 1.29; 95% CI, 1.05 to 1.59; p = 0.016). In contrast, patients with pre-diabetes did not demonstrate a statistically significant increase in postoperative complications compared to those without diabetes, indicating no significant differences in the odds ratios for complications between pre-diabetic patients and non-diabetic patients.

Conclusion : Type 2 diabetes mellitus is associated with a higher risk of both medical and surgical complications following short-segment lumbar fusion surgery. However, pre-diabetes does not appear to affect postoperative complication rates compared to patients without diabetes significantly. These findings suggest that while patients with DM2 require enhanced perioperative management to mitigate risks, pre-diabetic patients may not need additional interventions beyond standard care protocols.