Diabetes Is Predictive of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion

Study Design: Retrospective cohort study. Objective: The present study analyzes complication rates and episode-based costs for patients with and without diabetes mellitus (DM) following posterior lumbar fusion (PLF). Methods: PLF cases at a single institution from 2008 to 2016 were queried (n = 3226), and demographic and perioperative data were analyzed. Patients with and without the diagnosis of DM were compared using chi-square, Student'sttest, and multivariable regression modeling. Results: Patients with diabetes were older (63.10 vs 56.48 years,P< .001) and possessed a greater number of preoperative comorbidities (47.84% of patients had Elixhauser Comorbidity Index >0 vs 42.24%,P< .001) than did patients without diabetes. When controlling for preexisting differences, diabetes remained a significant risk factor for prolonged length of stay (OR = 1.59, 95% CI 1.26-2.01,P< .001), intensive care unit stay (OR = 1.52, 95% CI 1.07-2.17,P= .021), nonhome discharge (OR = 1.86, 95% CI 1.46-2.37,P< .001), 30-day readmission (OR = 2.15, 95% CI 1.28-3.60,P= .004), 90-day readmission (OR = 1.65, 95% CI 1.05-2.59,P= .031), 30-day emergency room visit (OR = 2.15, 95% CI 1.27-3.63,P= .004), and 90-day emergency room visit (OR = 2.27, 95% CI 1.41-3.65,P< .001). Cost modeling controlling for overall comorbidity burden demonstrated that diabetes was associated with a $1709 increase in PLF costs (CI $344-$3074,P= .014). Conclusions: The present findings indicate a correlation between diabetes and a multitude of postoperative adverse outcomes and increased costs, thus illustrating the substantial medical and financial burdens of diabetes for PLF patients. Future studies should explore preventive measures that may mitigate these downstream effects.