Insulin dependence predicts adverse outcomes following lumbar spine surgery

Lumbar spine surgery procedures have been increasing amid a growing population with diabetes mellitus (DM) with limited studies available focusing exclusively on insulin dependence as a risk factor. The objective of this study was to evaluate the differential impact of insulin dependence on perioperative outcomes following lumbar spine surgery.

The American College of Surgeons National Surgical Quality Improvement Program database was queried to retrospectively identify patients who had undergone lumbar spine surgery between 2011 and 2022. The study population was divided into three distinct groups based on diabetic status: insulin-dependent DM (IDDM), insulin-independent DM (NIDDM), and no DM (non-DM). One-way analysis of variance for continuous variables and Chi-square tests for categorical variables were used to identify differences in perioperative variables between the three groups. Multivariable logistic regression analysis assessed the effect of DM status on postoperative surgical outcomes.

A total of 349,520 lumbar spine patients were identified, of whom 20,159 were IDDM, 43,402 were NIDDM, and 285,959 were non-DM. Both IDDM (odds ratio [OR]: OR: 1.134, 95% CI [1.059-1.214]) independently increased the risk for surgical complications, whereas only IDDM increased the risk for medical (OR: 1.256, 95% CI [1.194-1.320] complications following a multivariate logistic regression analysis.

This study highlights the increased risk of surgical and medical complications in patients with IDDM undergoing lumbar spine surgery. Both NIDDM and IDDM are independent risk factors for postoperative medical and surgical complications. These findings can be used to improve preoperative management and risk stratification for insulin dependent DM patients.