The Association of Perioperative Glycemic Control with Deep Postoperative Infection After Anterior Cervical Discectomy and Fusion in Patients with Diabetes

作者：Cancienne Jourdan M; Werner Brian C; Hassanzadeh Hamid; Singla Anuj; Shen Frank H; Shimer Adam L

来源：World Neurosurgery, 2017, 102: 13-17.

DOI：10.1016/j.wneu.2017.02.118

• ACDF
• Complication
• Diabetes
• HbA1c
• Infection

OBJECTIVE: To evaluate the association of perioperative hemoglobin A(1c) (HbA(1c)) level in patients with diabetes with the incidence of infection after anterior cervical discectomy and fusion requiring operative intervention, in addition to determining if a threshold level of HbA1c above which the risk of infection increases significantly exists.
METHODS: A national administrative database was queried for patients who underwent primary anterior cervical discectomy and fusion with diabetes who had a perioperative HbA(1c) level recorded within 3 months of surgery. These patients were stratified based on their HbA(1c) level in 0.5-mg/dL increments from < 5.49 mg/dL to > 11.5 mg/dL. The incidence of infection requiring operative intervention within 1 year was then identified using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. A receiver operating characteristic (ROC) analysis was performed to determine a threshold value of the HbA(1c) level.
RESULTS: A total of 3341 patients with a perioperative HbA(1c) level were included. The rate of deep infection requiring irrigation and debridement postoperatively stratified by HbA(1c) level ranged from a low of 1.5% to a high of 6.4% and was significantly correlated with increasing HbA(1c) levels (P = 0.005). The results of ROC analysis determined that the inflection point of the ROC curve corresponded to an HbA(1c) level higher than 7.5 mg/dL (P = 0.022; area under the curve, 0.67; specificity, 68%; sensitivity, 46%).
CONCLUSIONS: The risk of deep postoperative infection in patients with diabetes mellitus increases as the perioperative HbA(1c) level increases. ROC analysis determined that a perioperative HbA(1c) level higher than 7.5 mg/dL could serve as a threshold for a significantly increased risk of infection.

• 出版日期2017-6