Related Experiment Video
Updated: Jul 19, 2026
Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation
Published on: June 26, 2018
Impact of Glycemic Control on Surgical Site Infections in Neuromodulation Pain Procedures: A Retrospective Analysis
Julissa Mireles1, Albert Huh2, Jian Wang3
1Tilman J. Fertitta Family College of Medicine at University of Houston, Houston, TX.
Background:
Surgical site infections (SSIs) are common and preventable postoperative complications that contribute to increased morbidity, mortality, and health care costs. Diabetes mellitus (DM) is a known risk factor for SSIs across multiple surgical specialties, with poor perioperative glycemic control linked to higher infection rates. While neuromodulation procedures carry infection risks, optimal glycemic targets for these procedures remain unclear. Identifying an optimal glycemic threshold could improve infection rates and patient outcomes within this growing field of neuromodulation.
Objectives:
To examine and compare the effects of Type 1 and Type 2 DM as well as those of hemoglobin A1c (HbA1c), perioperative glucose levels, DM status, and insulin use in association with neuromodulation pain management procedures.
Study Design:
A single-center retrospective chart review.
Setting:
This study was conducted at the University of Texas MD Anderson Cancer Center.
Methods:
This retrospective study examined neuromodulation surgical cases between October 2019 to July 2024 to ascertain the postoperative infection factors. Among the variables studied were demographics, clinical factors, and surgical outcomes. After reviewing the charts of patients who had received qualifying procedures, the researchers investigated any infections that developed in those individuals.
Results:
From the 297 surgical cases analyzed, 9 (3%) yielded SSIs. The rate of SSI was significantly higher in patients with Type 1 DM (P = 0.0102), HbA1c levels > 7 (P = 0.0026), perioperative glucose > 200 mg/dl (P = 0.0088), presence of DM (P = 0.0111), and insulin use (P = 0.0244). Data specifically showed a 6.23-fold increase in the odds of developing postoperative infections for DM patients, an 8.72-fold increase in the odds for those with type 1 DM in particular, and an 8.56-fold increase in the odds for patients with HbA1c > 7 over those with an HbA1c < 7.
Limitations:
Due to the retrospective design of this study, the data eligible for collection were limited to what could be found within the charts available in the electronic medical record. Therefore, the data might have been susceptible to potential confounding and bias.
Conclusions:
Patients with type 1 diabetes, HbA1c > 7, perioperative glucose > 200 mg/dl, presence of DM, and a history of insulin use demonstrated a significantly higher risk of developing postoperative infections after neuromodulation procedures. Identifying the variables that contribute to postoperative infection is important to further reduce surgical complications. Future research goals include establishing glycemic targets for patients who inquire about undergoing neuromodulation procedures to improve those patients' outcomes.
Insights
Patients with diabetes mellitus, particularly Type 1, and elevated HbA1c levels face higher surgical site infection risks after neuromodulation procedures. Optimizing glycemic control is crucial for improving outcomes in these patients.
Area of Science:
- Neuromodulation
- Diabetes Mellitus Management
- Surgical Site Infections (SSIs)
Background:
- Surgical site infections (SSIs) are common postoperative complications, increasing morbidity, mortality, and healthcare costs.
- Diabetes mellitus (DM) is a significant risk factor for SSIs, with poor glycemic control exacerbating this risk.
- Optimal glycemic targets for neuromodulation procedures, a growing field, are not well-established, necessitating further investigation.
Purpose of the Study:
- To investigate the association between diabetes mellitus (Type 1 and Type 2), glycemic control (HbA1c, perioperative glucose), and insulin use with postoperative infection risk following neuromodulation procedures.
- To compare the infection risks associated with different diabetes profiles and glycemic management strategies in patients undergoing neuromodulation.
Main Methods:
- A single-center retrospective chart review was conducted at the University of Texas MD Anderson Cancer Center.
- Data from 297 neuromodulation surgical cases between October 2019 and July 2024 were analyzed.
- Patient demographics, clinical factors, surgical outcomes, and postoperative infection development were assessed.
Main Results:
- The overall SSI rate was 3% (9 cases).
- Significantly higher SSI rates were observed in patients with Type 1 DM (P=0.0102), HbA1c > 7% (P=0.0026), perioperative glucose > 200 mg/dL (P=0.0088), presence of DM (P=0.0111), and insulin use (P=0.0244).
- Patients with DM had a 6.23-fold increased odds of infection, Type 1 DM patients had an 8.72-fold increase, and those with HbA1c > 7 had an 8.56-fold increase compared to controls.
Conclusions:
- Type 1 diabetes, HbA1c levels above 7%, perioperative glucose exceeding 200 mg/dL, existing DM, and insulin use are associated with a significantly higher risk of SSIs after neuromodulation.
- Identifying these risk factors is crucial for mitigating surgical complications and improving patient outcomes.
- Future research should focus on establishing specific glycemic targets for patients undergoing neuromodulation to enhance safety and efficacy.
Related Concept Videos
01:29Blood and Nerve Supply to the Bones
Nutrient Artery
The nutrient artery is the main blood vessel that enters the diaphysis via the nutrient foramen. While most long bones have only one nutrient foramen, large bones, such as the femur, may have two. This...
01:23Peripheral Artery Disease V: Postoperative Nursing Management