Association of Elevated Perioperative Blood Glucose With Complications and Postoperative Outcomes Following Traumatic Spine Surgery

Yianni Bakaes; Michael Spitnale; Chase Gauthier; Justin E. Kung; David Edelman; Richard Bidwell; Michel Shahid; Gregory Grabowski

doi:10.14444/8627

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Table 1

Descriptive variables—all patients.

Factor	Mean (SD)	Minimum	Maximum
Patient variables
Age	52.4 (19.0)	18	94
Gender, n (%)
Female	96 (23.4)	-	-
Male	314 (76.6)	-	-
Race, n (%)
White	206 (50.5)	-	-
Black	174 (42.7)	-	-
Other	28 (6.9)	-	-
Body mass index	28.2 (7.5)	12.4	63
CCI	1.8 (2.0)	0	9
Clinic/ED variables
BAC	61.5 (101.2)	0	417
ED O₂ saturation	96.0 (4.1)	69	100
ED Glasgow Coma Scale	13.8 (3.1)	3	15
ISS	17.8 (12.6)	4	75
TRISS	0.9 (0.2)	0.01	0.99
Quantity of complication variables
Cardiac	0.0 (0.2)	0	2
Deep vein thrombosis	0.1 (0.3)	0	2
Genitourinary	0.2 (0.6)	0	5
Nervous system	0.2 (0.4)	0	2
Oropharynx	0.1 (0.4)	0	2
Postoperative infection	0.1 (0.4)	0	3
Respiratory	0.2 (0.6)	0	4
Skin/wound	0.1 (0.4)	0	4
Total complication categories affected	1.2 (1.4)	0	7
Total individual complications	1.4 (1.8)	0	11
Glucose and other outcome variables
HbA1C	6.2 (1.6)	4.6	12.6
Highest glucose reading prior to surgery	139.2 (56.4)	63	671
Highest glucose reading within 72 h postoperative	163.1 (67.7)	83	547
If postoperative glucose was >200 mg/dL, how many times?	0.8 (2.8)	0	22
Total hospital days	22.9 (31.8)	1	281
Total ICU days	6.7 (9.9)	0	103
Total ventilator days	4.6 (13.3)	0	117
ASIA grade at most recent follow-up	4.4 (1.1)	1	5
Best ASIA grade within 1 wk of injury postop	4.0 (1.2)	1	5
Preoperative ASIA grade	3.9 (1.2)	1	5

Abbreviations: ASIA, American Spinal Injury Association Impairment Scale; BAC, blood alcohol concentration; CCI, Charlson Comorbidity Index; ED, emergency department; ICU, intensive care unit; ISS, Injury Severity Score; TRISS, Trauma Score and Injury Severity Score.
Note: Data presented as mean (SD) unless otherwise noted.

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Table 2

Categorical/continuous variable comparison—postoperative glucose <200 and ≥200 mg/dL and preoperative glucose <200 and ≥200 mg/dL.

Factor	Postoperative Glucose <200 mg/dL (n = 333)	Postoperative Glucose ≥200 mg/dL (n = 68)	P	Preoperative Glucose <200 mg/dL (n = 374)	Preoperative Glucose ≥200 mg/dL (n = 34)	P
Age, y, mean (SD)	50.7 (19)	62 (15.9)	<0.01	52 (19.4)	56.7 (3.2)	<0.01
Gender, n (%)
Female	81 (24.3)	14 (20.6)	0.51	88 (23.5)	8 (23.5)	>0.99
Male	252 (75.7)	54 (79.4)		286 (76.5)	26 (76.5)
Race, n (%)
Black or African American	145 (43.8)	22 (32.4)	0.04	164 (43.9)	8 (23.5)	0.02
Caucasian	161 (48.6)	44 (64.7)		182 (48.7)	25 (73.5)
Other Race	25 (7.6)	2 (2.9)		28 (7.5)	1 (2.9)
BMI, mean (SD)	27.7 (7.2)	30.5 (8.3)	0.01	27.7 (7.4)	32.4 (7.2)	<0.01
Diagnosis of Diabetes, n (%)
No	300 (90.1)	21 (30.9)	<0.01	314 (83.9)	13 (38.3)	<0.01
Yes	33 (9.9)	47 (69.1)		60 (16)	21 (61.8)
Respiratory Complication, n (%)
No	290 (87.1)	52 (76.5)	0.02	324 (86.6)	24 (70.6)	0.03
Yes	43 (12.9)	16 (23.5)		51 (13.6)	10 (29.4)
Skin/wound Complication, n (%)
No	306 (91.9)	57 (83.8)	0.04	342 (91.4)	27 (79.4)	0.03
Yes	27 (8.1)	11 (16.2)		32 (8.6)	7 (20.6)
CCI, mean (SD)	1.5 (1.9)	3.4 (2.1)	<0.01	1.8 (2.0)	2.8 (2.3)	<0.01
Total Hospital Days, mean (SD)	21.2 (28.5)	30.9 (43.6)	0.01	21.9 (31.9)	34.1 (29.3)	<0.01
Total ICU Days, mean (SD)	6.4 (10.2)	7.9 (7.7)	0.02	6.5 (10)	9.2 (8.2)	0.01
Total Ventilator Days, mean (SD)	3.9 (11.6)	6.9 (16.9)	0.01	4.5 (13.7)	5.8 (8.3)	0.01
ASIA Grade at most recent follow-up, mean (SD)	4.4 (1)	4 (1.4)	0.15	4.4 (1.1)	4.3 (0.91)	0.17
Best ASIA grade within 1 week of injury postop, mean (SD)	4 (1.2)	3.7 (1.4)	0.17	4 (1.2)	4 (0.95)	0.48
Preop ASIA Grade, mean (SD)	3.9 (1.2)	3.7 (1.5)	0.59	3.9 (1.3)	3.9 (1.0)	0.91
Discharge Status, n (%)
Alive	326 (97.9)	63 (92.7)	0.04	362 (96.8)	34 (100)	0.61
Dead	7 (2.1)	5 (7.4)		12 (3.2)	0 (0)

Abbreviations: ASIA, American Spinal Injury Association Impairment Scale; BMI, body mass index; CCI, Charleson Comorbidity Index; ICU, intensive care unit.

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Table 3

Unadjusted odds ratios and Wald CIs for comparisons of postoperative and preoperative glucose levels.

Comparison	OR (95% CI)	P
Postoperative glucose ≥200 compared with <200 mg dL
Respiratory complication, yes vs no	2.1 (1.1–4)	0.03
Skin/wound complication, yes vs no	2.2 (1–4.7)	0.04
Increase in hospital length of stay, d	9.6 (1.4–17.9)	0.03
Increase in ICU stay, d	1.5 (−1.1–4.1)	0.26
Increase in time on ventilator, d	2.9 (−0.39–6.4)	0.09
Discharge status, dead vs alive	3.7 (1.1–12)	0.03
Preoperative glucose ≥200 compared with <200 mg dL
Respiratory complication, yes vs no	2.1 (1.1–3.8)	0.02
Skin/wound complication, yes vs no	2.8 (1.4–5.7)	0.01
Increase in hospital length of stay, d	12.1 (0.97–23.3)	0.03
Increase in ICU stay, d	2.7 (−0.75–6.2)	0.12
Increase in time on ventilator, d	1.4 (−3.3–6.1)	0.57

Abbreviation: ICU, intensive care unit.

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Table 4

Univariate linear regression analysis for increase in ASIA score.

Factor	OR (95% CI)	P
Postoperative glucose ≥200 mg/dL	−0.4 (−0.81 to −0.01)	0.048
Preoperative glucose ≥200 mg/dL	−0.13 (−0.65–0.38)	0.61
Age	0.004 (−0.003–0.01)	0.28
Female gender	−0.08 (−0.41–0.24)	0.62
CCI	0.02 (−0.07–0.1)	0.7
ED GCS	0.08 (0.03–0.12)	<0.01
BMI	−0.01 (−0.03–0.02)	0.59
ISS	−0.05 (−0.06 to −0.04)	<0.01
TRISS	0.06 (−0.2–0.33)	0.63
Total ventilator days	−0.04 (−0.05 to −0.03)	<0.01
Total ICU days	−0.06 (−0.07 to −0.04)	<0.01
Total hospital days	−0.02 (−0.02 to −0.01)	<0.01
Preoperative ASIA grade	0.76 (0.69–0.83)	<0.01
Caucasian race	0.1 (−0.19–0.39)	0.5
Black race	−0.08 (−0.37–0.21)	0.59
Positive alcohol screen	−0.45 (−0.74 to −0.16)	<0.01
ED supplemental O₂	−0.61 (−0.97 to −0.26)	<0.01
History of smoking	0.12 (−0.18–0.42)	0.42
Chronic steroid use	0.44 (−0.55–1.4)	0.39
Pulmonary embolism	−0.58 (−1.6–0.4)	0.25
Infection	−0.59 (−1.1 to −0.04)	0.03
Cerebrovascular complication	0.03 (−0.96–1.0)	0.95
Respiratory complication	−0.92 (−1.3 to −0.57)	<0.01
Nervous system complication	−0.6 (−1.1 to −0.13)	0.01
Postoperative shock	0.13 (−1.4–1.7)	0.87
Skin/wound complication	−1.6 (−2.0 to −1.2)	<0.01
Preoperative steroids	−0.31 (−0.69–0.07)	0.11

Abbreviations: ASIA, American Spinal Injury Association Impairment Scale; BMI, body mass index; CCI, Charleson Comorbidity Index; ED, emergency department; GCS, Glasgow Coma Scale; ICU, intensive care unit; ISS, Injury Severity Score; TRISS, Trauma Score and Injury Severity Score.

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Table 5

Multivariate linear regression analysis for increase in ASIA score.

Factor	OR (95% CI)	P
Postoperative glucose ≥200 mg/dL	−0.27 (−0.52–0.01)	0.06
Preoperative glucose ≥200 mg/dL	0.13 (−0.19–0.44)	0.44
ED GCS	−0.01 (−0.05–0.03)	0.6
ISS	−0.01 (−0.01–0.01)	0.39
Total ventilator days	−0.01 (−0.02–0.003)	0.16
Total ICU days	−0.01 (−0.02–0.01)	0.62
Total hospital days	−0.001 (−0.005–0.002)	0.42
Preoperative ASIA grade	0.65 (0.55–0.74)	<0.01
Positive alcohol screen	−0.02 (−0.21–0.17)	0.84
ED supplemental O₂	−0.001 (−0.03–0.02)	0.91
Infection	−0.02 (−0.38–0.34)	0.92
Respiratory complication	−0.19 (−0.45–0.07)	0.15
Nervous system complication	0.28 (−0.03–0.58)	0.08
Skin/wound complication	−0.3 (−0.65–0.06)	0.1

Abbreviations: ASIA, American Spinal Injury Association Impairment Scale; ED, emergency department; GCS, Glasgow Coma Scale; ICU, intensive care unit; ISS, injury severity score.