RT Journal Article
SR Electronic
T1 The Effects of Blood Glucose Control in the Operative Spine Patient: A Systematic Review
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 779
OP 786
DO 10.14444/8547
VO 17
IS 6
A1 Richard Bidwell
A1 Michael Spitnale
A1 Rodrigo Encinas
A1 Yianni Bakaes
A1 Justin Kung
A1 Gregory Grabowski
YR 2023
UL http://ijssurgery.com//content/17/6/779.abstract
AB Objective To our knowledge, this is the first systematic review to evaluate the available literature on the effects of perioperative serum glucose (SG) on outcomes for patients undergoing spine surgery. This review will add insight into how the perioperative management of SG affects the outcomes of patients undergoing spine surgery.Methods Three databases were used in this review including Embase, PubMed, and Cochrane Library. The searches were from 2012 to 2022 and included the terms “spine surgery” and “glucose level” to identify studies that demonstrated a correlation between glucose level and postoperative outcomes. Pediatric studies, those that did not specify spine surgical outcomes related to glucose levels, and non-English studies were excluded. The methodological items for nonrandomized studies score was used to assess risk of bias in the included studies.Results This review included a total of 9 cohort studies, both prospective and retrospective, encompassing a total of 431,156 subjects. Seven of the 9 studies reported an increased overall complication rate among patients with diabetes or with higher SG levels, and 4 studies demonstrated an increased infection rate among this population. Two studies reported an association between decreased SG levels and improved neurological recovery when a deficit was present preoperatively, and 1 of the studies found that this association was statistically significant.Limitations Limitations of this review include lack of standardization regarding type of surgery, location of the spine, and level of evidence.Conclusion Most of the current literature suggests that elevated SG levels in patients undergoing spine surgery likely leads to higher complication rates and may lead to increased infection rates, and this review reinforced the current evidence. Additionally, perioperative SG levels may be associated with the extent of neurological recovery after surgery, but further investigation may be warranted.Clinical Relevance This review adds to the current body of evidence regarding perioperative SG levels and its association with complications.Level of Evidence 2.