The Impact of Diabetes Mellitus on Length of Stay and Direct Hospital Costs after Minimally Invasive Transforaminal Lumbar Interbody Fusion Brittany E. Haws, MD1 ; Benjamin Khechen, BA1; Dil V. Patel, BS1; Ankur S. Narain, MD1; Mundeep S. Bawa, BA1; Harmeet S. Bawa, BA1; Kaitlyn L. Cardinal, BS1; Jordan A. Guntin, BS1; Sailee S. Karmarkar, BS1; Kern Singh, MD1,2 1 2 Department of Orthopaedic Surgery, Rush University Medical Center Professor, Co-Director of the Minimally Invasive Spine Institute at Rush University Medical Center; Founder and President, Minimally Invasive Spine Study Group
Disclosures Brittany E. Haws, Benjamin Khechen, Dil V. Patel, Ankur S. Narain, Mundeep S. Bawa, Harmeet S. Bawa, Kaitlyn L. Cardinal, Jordan A. Guntin, Sailee S. Karmarkar Nothing to disclose Kern Singh, MD Board Membership Vital 5 LLC, Avaz Surgical LLC Consultant Depuy, Zimmer, Stryker Royalties Zimmer, Stryker, Pioneer, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, Slack Publishing Grants Cervical Spine Research Society
Introduction Diabetes mellitus (DM) is one of the most prevalent conditions in the United States. In spine literature, DM has been associated with increased risk for postoperative complications, increased length of inpatient stay, and increased costs for a heterogenous mixture of procedure types.
Aims and Objectives To determine if the presence of DM as a comorbidity is associated with inpatient length of stay (LOS) or direct hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Methodology Retrospectively review prospectively-maintained database 100 patients that underwent a primary, single-level MIS TLIF for degenerative pathology from 2008 to 2016 Patient groups were propensity matched for age, gender, and comorbidity burden 100 Primary, Single-level MIS TLIF Patients Diabetic N = 50 Non-Diabetic N = 50
Methodology Variables Analyzed Patient demographics Operative variables Length of stay Complications Direct hospital costs Statistical Analyses Student s t-test Pearson s Chi-square analysis Multivariate linear regression
Results No differences in demographics identified between diabetics and nondiabetics.
Results No differences in perioperative characteristics, length of stay, or complication rate between diabetics and nondiabetics.
Results No differences in inpatient length of stay between diabetics and nondiabetics following MIS TLIF.
Results Diabetic status was not associated with differences in total direct hospital costs or cost subcategories after MIS TLIF.
Discussion Diabetes mellitus was NOT associated with increased length of stay or hospital costs after single-level MIS TLIF Limited operative exposure and tissue trauma in MIS TLIF may mitigate the risk of complications, and thus, length of stay and hospital costs in diabetic patients
Limitations Other comorbidities were not accounted for in this study. Patients were not substratified by insulin-dependent status or by Hemoglobin A1c levels. Complications after discharge or readmissions were not recorded.
Conclusions Diabetes was NOT associated with higher complication rates, length of stay, or hospital costs after primary, single-level MIS TLIF Reduced extent of operative exposure and tissue trauma in MIS TLIF may mitigate the risk of complications in diabetic patients, possibly preventing extensions in hospital length of stay and costs
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