Impact of prediabetes on postoperative outcomes following short-segment transforaminal lumbar interbody fusions

Type 2 diabetes mellitus (T2DM) is a well-established risk factor for adverse surgical outcomes, but the impact of prediabetes on spine surgery remains unexplored. This study evaluated the influence of prediabetes on postoperative complications in patients undergoing short-segment (≤3 levels) transforaminal lumbar interbody fusion (TLIF).

We retrospectively reviewed patients undergoing 1-3 level TLIF in a national administrative database. Patients were categorized into 3 groups: no diabetes, prediabetes, and T2DM. Patients with type 1 diabetes were excluded. A 1:1:1 exact match was performed to balance demographics, comorbidities, and the number of spinal levels fused. Thirty-day postoperative medical and surgical complications were analyzed.

A total of 17,796 patients (5,932 per group) were included. Patients with T2DM demonstrated a significantly higher incidence of urinary tract infection (OR, 1.49; 97.5% CI, 1.19-1.86), pneumonia (OR, 1.59; 97.5% CI, 1.10-2.31), acute kidney injury (OR, 2.32; 97.5% CI, 1.70-3.18), surgical site infection (OR, 1.34; 97.5% CI, 1.04-1.74), overall medical complications (OR, 1.50; 97.5% CI, 1.28-1.75), and surgical complications (OR, 1.29; 97.5% CI, 1.05-1.58). In contrast, patients with prediabetes did not demonstrate a statistically significant increase in postoperative complications.

T2DM is associated with a higher risk of medical and surgical complications following short-segment TLIF. However, prediabetes does not appear to affect postoperative complication rates. These findings suggest enhanced perioperative management is warranted for patients with T2DM, while standard protocols may be sufficient for patients with prediabetes.