Abstract
Introduction
Hyperglycemia in diabetic patients is a well-known risk factor for many perioperative morbidity and mortality, as it alters the normal physiology of the patients responding to many stressors like surgery, it therefore tends to increase the patients’ costs and length of stay in the hospital. Other studies have showed the relation between glycemic instability with the adverse events following spinal surgeries, showing as high as 19% non-diabetic patients, had hyperglycemia and considering it as a risk factor for many adverse events like surgical site infections and sub-optimal wound healing and for the increasing rates of surgical revision, matching our hypothesis of the positive correlation between glycemic instability and the rate of adverse events. The purpose of this study was to expose the effect of glucose level preoperatively on the patient complications and length of stay in the hospital, and to compare between diabetics and non-diabetics with hyperglycemia preoperatively regarding complications and length of stay.
Material and Methods
Of the 129 patients who underwent spinal surgeries at King Saud University Medical City, Riyadh SA, during two years period (2013–2015) exclusion and inclusion criteria were applied including only the patients whom their preoperative glucose level was documented and a total number of 106 patients were enrolled in a retrospective analysis study design. Each of the patients' records underwent a comprehensive and complete review.
Results
34 (32.1%) of our patients were diabetic, 13 (12.2%) of all patients had hyperglycemia, 6 (46.2%) of the hyperglycemic patients had at least one post-operative complication, compared with 9 (10.5%) among the euglycemics (P value 0.004), having most commonly infections and suboptimal wound healing (23.1%, n 3, P value 0.094, 0.192, respectively), with an increase in length of stay by an average of 4.37 days (P value 0.256) and the incidence of complications among the hyperglucemic ptients seen in 5 (55.6%) of the diabetics and in 1 (25.0%) of the non-diabetics(P value 0.343).
Conclusion
Pre-operative hyperglycemia is associated with more adverse events post operatively (seen more in diabetics in this study), hence, along with other factors, increasing patients' length of stay in the hospital which adds to the financial costs as well as predisposing to more infections. However, the number of diabetic patients examined in this study was limited, demanding for more extensive researches addressing the same topic.