Diabetes Is Related to Worse Patient-Reported Outcomes at Two Years Following Spine Surgery
Diabetes Is Related to Worse Patient-Reported Outcomes at Two Years Following Spine Surgery
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DOI：
10.2106/jbjs.o.00297
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发表时间：
2016-01-06
影响因子：
5.3
通讯作者：
Devin, Clinton J.
中科院分区：
文献类型：
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作者：
Armaghani, Sheyan J.;Archer, Kristin R.;Devin, Clinton J.
背景：糖尿病与择期脊柱手术后的不良结局相关。我们研究的目的是确定糖尿病是否预示着术后两年患者报告的预后更差，并评估围手术期血糖水平和血糖控制对糖尿病患者报告的预后的影响。记录糖尿病的存在情况和基线以及1年和2年患者报告的结局（简表-12 [SF-12]、EuroQol-5D [EQ-5D]、奥斯韦斯特里功能障碍指数[ODI]或颈部功能障碍指数[NDI]和数字评定量表[NRS]疼痛评分）。在术后期间收集糖尿病患者的平均血糖测量值。进行多变量线性回归分析，以确定1年和2年的结果以及围手术期血糖和患者报告的糖尿病患者的结局之间的关系的预测因素。结果：434例（43%）有糖尿病。与非糖尿病患者相比，糖尿病患者的SF-12身体健康总评评分较低（糖尿病组34.4分，非糖尿病组38.6分），EQ-5D评分较低（糖尿病组为0.67，非糖尿病组为0.74），ODI或NDI评分较高（糖尿病组为32.1分，非糖尿病组为26.8分），NRS评分较高（糖尿病组5.1分，非糖尿病组4.3分）（均P <0.05）。尽管糖尿病患者随时间推移显著改善，但他们在ODI或NDI和EQ-5D评分方面的改善程度不及非糖尿病患者（p <0.05）。糖尿病和术前阿片类药物使用是SF-12评分降低、EQ-5D评分降低、ODI或NDI评分升高和NRS评分升高的独立预测因素（p <0.05）。2年时，糖尿病与ODI或NDI增加（6.6分）和EQ-5D降低（0.1）相关。围手术期血糖控制并不能预测糖尿病患者术后1年或2年的结局。结论：糖尿病患者与非糖尿病患者在择期脊柱手术后2年进行比较时，糖尿病患者报告的结局较差。尽管与基线相比，糖尿病患者在择期脊柱手术后有所改善，但他们的ODI或NDI和EQ-5D评分改善程度与非糖尿病患者不同。提供者可以使用这些信息来咨询糖尿病患者脊柱手术后的期望。
Background: Diabetes has been associated with poor outcomes following elective spine surgery. The purpose of our study was to determine if diabetes predicts worse patient-reported outcomes at two years postoperatively and to evaluate the effect of perioperative blood glucose levels and control on patient-reported outcomes in patients with diabetes.Methods: One thousand and five patients undergoing elective spine surgery were included in this prospective cohort study. The presence of diabetes and baseline and one and two-year patient-reported outcomes (Short Form-12 [SF-12], EuroQol-5D [EQ-5D], Oswestry Disability Index [ODI] or Neck Disability Index [NDI], and Numeric Rating Scale [NRS] pain scores) were recorded. The mean blood glucose measurements in patients with diabetes were collected during the postoperative period. Multivariable linear regression analyseswere performed to determine predictors of one and two-year outcomes aswell as the relationship between perioperative blood glucose and patient-reported outcomes in patients with diabetes.Results: Four hundred and thirty-four patients (43%) had diabetes. When compared with patients without diabetes at two years, patients with diabetes had lower SF-12 Physical Component Summary scores (34.4 points for the diabetic group compared with 38.6 points for the non-diabetic group), lower EQ-5D scores (0.67 for the diabetic group compared with 0.74 for the non-diabetic group), higher ODI or NDI scores (32.1 points for the diabetic group compared with 26.8 points for the non-diabetic group), and higher NRS scores (5.1 points for the diabetic group compared with 4.3 points for the nondiabetic group) (p < 0.05 for all). Although patients with diabetes improved significantly over time, they did not improve to the extent that patients without diabetes did in the ODI or NDI and EQ-5D scores (p < 0.05). Diabetes and preoperative opioid use were independent predictors of decreased SF-12 scores, decreased EQ-5D scores, increased ODI or NDI scores, and increased NRS scores (p < 0.05). Diabetes was associated with increased ODI or NDI (by 6.6 points) and decreased EQ-5D (by 0.1) at two years. Perioperative blood glucose control did not predict outcomes at either one or two years in patients with diabetes.Conclusions: Diabetes was associated with worse patient-reported outcomes when patients with diabetes were compared with patients without diabetes at two years following elective spine surgery. Although patients with diabetes improved when compared from baseline to the time following elective spine surgery, they did not improve to the same extent as patients without diabetes in the ODI or NDI and EQ-5D scores. Providers may use this information to counsel patients with diabetes on expectations following spine surgery.