Comparison of spinal deformity surgery in patients with non-insulin-dependent diabetes mellitus (NIDDM) versus controls.
ABSTRACT A retrospective review.
To quantify the exact impact of non-insulin-dependent diabetes mellitus (NIDDM) on operative complications and additional surgeries associated with spinal deformity surgery.
There are many references supporting diabetes mellitus (DM) as one of the major risk factors for perioperative complications in spinal surgery. However, the results vary depending on the type of DM, suggesting that insulin-dependent DM causes more complications than NIDDM, which is far more prevalent in the adult population with spinal deformity.
Among 5119 adult patients (older than 40 yr) with deformities, 23 patients with NIDDM and 23 control (group C) patients with a minimum 2-year follow-up were selected. Both groups were matched for age at surgery, sex, body mass index, number of comorbidities, smoking history, current and prior fusion levels, estimated blood loss, and the amount of transfusion. Pre- and final Scoliosis Research Society (SRS) scores and Oswestry Disability Index (ODI), number of perioperative complications, and additional surgeries were compared. Within the group with NIDDM, patients with (+) or without (-) complications were compared in terms of postoperative glucose control.
There were no significant differences in the number of major or minor complications or additional surgeries between the 2 groups. There was no significant difference in postoperative glucose control with the NIDDM group (+) and (-). Group C reported significantly improved scores at final follow-up in all SRS domains and ODI. The group with NIDDM reported improvement in all domains except for the mental health and pain domains. However, there were no significant differences between the group with NIDDM and group C in terms of SRS and ODI scores preoperatively and postoperatively.
Contrary to traditional thinking, properly selected NIDDM was not a significant risk factor for perioperative complications or additional surgeries in adult patients with spinal deformities.