Preoperative hemoglobin A1c and minimally invasive lumbar spine surgery: is it as critical as we think

Minimally invasive approaches to lumbar spine surgery are increasingly popular. Current guidelines highlight the importance of preoperative HbA1c in optimizing spine surgery outcomes. However, the role of preoperative HbA1c in minimally invasive lumbar spine surgery remains unclear.

We sought to assess the association of HbA1c with readmissions, reoperations, and complications following minimally invasive lumbar spine surgery.

We retrospectively reviewed all adult patients at a single institution from 2011 to 2023 who underwent minimally invasive lumbar decompression or decompression with instrumented fusion using CPT and ICD9/10 codes. Multivariate logistic regressions were performed to assess the effect of high HbA1c on readmissions and reoperations.

In total, 1013 [median age 64 (IQR 54-71)] patients met the inclusion criteria. The median preoperative HbA1c was 5.99% (IQR 5.62 - 6.39). Upon multivariate regression analysis adjusting for frailty, socioeconomic status, and other confounders, patients with high HbA1c (> 7.1) had increased odds of unplanned readmission within 90 days (OR 2.02, 95% CI 1.10- 3.56, p = 0.019) and reoperation within 90 days (OR 2.82, 95%CI 1.14-6.31) of the index operation. Patients with high HbA1c also had increased odds of requiring reoperation due to persistent symptoms (OR 2.9, 95%CI 0.91-7.87, p = 0.048). After propensity score matching, patients with high HbA1c also had prolonged hospital lengths of stay (1.32 days vs 1.24 days, p = 0.006), post operative UTI (4.7% vs 0.9%, p = 0.034).

Our results suggest high preoperative HbA1C may be associated with increased rates of readmission and reoperation following minimally invasive lumbar spine surgery. Preoperative HbA1C control may be indicated for surgical optimization in minimally invasive lumbar spine surgery.