Elevated Levels of Hemoglobin A1C Are Not Associated With Increased Complication Rates After Anterior Cervical Discectomy and Fusion.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

To assess the relationship between preoperative HbA1c and postoperative complications up to 180 days in prediabetic and diabetic patients undergoing anterior cervical discectomy and fusion.

SUMMARY OF BACKGROUND DATA: Diabetes mellitus has been associated with an increased complication rate and poor postoperative outcomes in patients undergoing elective spine surgeries, but few publications have fully analyzed the effect of preoperative HbA1c on postoperative complications in the cervical spine.

METHODS

Patients diagnosed with prediabetes or diabetes who underwent anterior cervical discectomy and fusion between 2018 and 2022. Patients were categorized based on their preoperative HbA1c levels: category I with HbA1c levels from 5% to 6.5%, category II from 6.6% to 8%, and category III>8%. Demographics, preoperative glucose and HbA1c levels, and postoperative complications were collected. Postoperative complications were categorized as revision, dysphagia, wound, and other. Pearson χ 2 tests and regression models/analyses were used.

RESULTS

The current study included 75 patients. Within 30 days postoperatively, there was 1 patient in category I, 1 in category II, and 2 in category III with documented complications. At 31-90 days, only 1 patient in category III reported a complication. There were no complications 91-180 days postoperatively. There was no statistically significant difference in complication or revision rates among the categories at all postoperative time intervals.

CONCLUSIONS

In the current study, no statistically significant difference was found between elevated HbA1c level and complication rates between diabetics categorized by HbA1c levels at all postoperative time intervals. Future studies are necessary to develop a multifactorial approach to medical clearance in diabetic patients that qualify for cervical spine surgeries.