P18. Evaluating the impact of NPO duration on postoperative glucose variability and outcomes following lumbar fusion in diabetic patients

• Published in: The spine journal Vol. 24; no. 9; pp. S71 - S72
• Main Authors: Tomlak, Alexa, Narayanan, Rajkishen, Lee, Yunsoo, Tarawneh, Omar, Sirapu, Shruti, Sumughan, Saurav, Vaccaro, Alexander R., Hilibrand, Alan S., Canseco, Jose A, Schroeder, Gregory Douglas, Kepler, Christopher K., Prasad, Vignesh, Sun, Mengyi
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-09-2024
• ISSN: 1529-9430
• DOI: 10.1016/j.spinee.2024.06.039

Diabetes mellitus (DM) is a risk factor for compromised postoperative wound healing, decreased spinal fusion rates, and incidence of surgical site infections. Furthermore, studies have shown a relationship between increased serum glucose variability in the postoperative phase and adverse outcome. It has been hypothesized that earlier morning surgeries may be beneficial in reducing these risks in diabetic patients and controlling postoperative glucose variability minimizing time spent NPO
This study aims to explore whether there is a relationship between time spent NPO and postoperative glucose variability as well as outcomes following lumbar fusion surgery in diabetic patients.
Single institution retrospective cohort study.
Patients with Type I or Type II diabetes mellitus undergoing elective lumbar fusion surgery.
Primary outcomes for this study included glycemic variability, length of hospital stay, postoperative inpatient complications, discharge disposition, 30-day and 90-day postoperative readmissions and ED utilization, and 1-year reoperation and revision rates. Secondary outcomes included patient-reported outcomes measures: Visual Analog Scale (VAS) Back and Leg, Oswestry Disability Index (ODI), SF-12 Mental Component Summary (MCS) and Physical Component Summary (PCS)
This study included diabetic patients undergoing elective lumbar fusion surgery from 2017 to 2021. Retrospective data collection encompassed patient demographics, surgical details, inpatient point-of-care (POC) glucose values, and postoperative complications. Information on diabetes type, insulin/oral medication use, and preoperative HBA1c was collected. Patients were categorized based on total time spent. Patients were stratified into one of three groups based on total time spent NPO: <12 hours vs 12-15 hours vs 15+ hours. Total time spent NPO was calculated based on the difference between reported time NPO in the operative anesthesia encounter and scheduled procedure start time. Inpatient postoperative glucose values were evaluated for variability using the coefficient of variation (COV), which measures relative variability around the mean glucose level. Statistical analyses were conducted for group comparisons.
A total of 346 patients met the inclusion criteria for this study (<12 hrs NPO: 104, 12-15 hrs NPO: 122, 15+ hrs NPO: 120). Similar distributions of Type I vs Type II diabetes and preoperative diabetic medication types were observed across groups. Glycemic variability did not vary based on time spent NPO (<12 hrs NPO: 20.0 [15.9;25.0] vs 12-15 hrs NPO: 19.1 [14.0;24.2] vs 15+ hrs NPO: 20.3 [16.8;25.7]; p=0.291). Likewise, postoperative inpatient complications, length of hospital stay, discharge disposition, and 1-year reoperation and revision rates did not display statistically significant differences between groups. Patient-reported outcome measures at preoperative, 6-month postoperative, and 1-year postoperative intervals showed comparable results except for 1-year postoperative SF-12 PCS, where the <12 hours NPO group had higher scores (<12 hrs NPO: 32.0 [28.8;35.7] vs 12-15 hrs NPO: 29.2 [25.2;37.8] vs 15+ hrs NPO: 27.5 [24.7;34.9]; p=0.049).
This study indicates that the timing of surgical interventions for diabetic patients undergoing lumbar fusion procedures, particularly regarding NPO duration, does not significantly affect overall outcomes. Further investigation is warranted to delineate factors contributing to adverse postoperative outcomes in diabetic populations and potential mitigation strategies.
This abstract does not discuss or include any applicable devices or drugs.