Blood sugar fluctuations tied to adverse outcomes following lumbar fusion: Study
USA: Postoperative glycemic variability is associated with inpatient complications, 90-day adverse outcomes, and length of stay in patients who have undergone one- to three-level lumbar fusion, finds a recent study.
"While HbA1c has classically been used as the principal marker for assessing blood sugar control, our results show glycemic variability to be a strong predictor of postoperative adverse outcomes," the researchers wrote in the journal Spine.
Numerous patient characteristics have been shown to be associated with surgical outcomes after lumbar fusion. Recent studies have described measuring postoperative glycemic variability to be another promising marker. To obtain more information on the topic, Jose A Canseco, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, and colleagues evaluated the effect size of postoperative glycemic variability on surgical outcomes among patients who have undergone one- to three-level lumbar fusion in a retrospective cross-sectional study.
A total of 850 patients were stratified into tertiles (low, moderate, high) based on the degree of postoperative glycemic variability defined by the coefficient of variation (CV). Surgical site infections were determined via chart review based on the CDC definition. Demographic factors, surgical characteristics, inpatient complications, readmissions, and reoperations were determined by chart review and telephone encounters.
The research yielded the following findings:
- A statistically significant difference in 90-day adverse outcomes was observed when stratified by postoperative glycemic variability. In particular, patients with high CV had higher odds of readmission (OR = 2.19), experiencing a surgical site infection (OR = 3.22), and undergoing reoperations (OR = 2.65) compared with patients with low CV.
- No significant association was seen between low and moderate CV groups.
- Higher CV patients were more likely to experience longer hospital stays.
- Among the three groups, high CV group experienced the highest proportion of complications.
"Our study establishes a significant relationship between postoperative glycemic variability and inpatient complications, length of stay, and 90-day adverse outcomes," wrote the authors. However, there is a need for future high-quality, prospective studies to explore the true effect of CV, as well s its practicality in clinical practice, they added.
The researchers concluded, "fluctuations in blood glucose levels during the inpatient stay should be limited to improve patient results."
The study titled, "Postoperative Glycemic Variability as a Predictor of Adverse Outcomes Following Lumbar Fusion," is published in the journal Spine.