Preoperative HbA1c Levels and Outcomes in Minimally Invasive Lumbar Spine Surgery

Overview

This retrospective cohort study evaluated the impact of elevated preoperative hemoglobin A1c (HbA1c >7.1%) on outcomes following minimally invasive lumbar spine surgery. Findings suggest that high HbA1c is associated with increased risk of unplanned readmissions and wound complications, underscoring the importance of glycemic optimization even in minimally invasive procedures.

Background

Spine surgery is increasingly common, especially in aging populations, with a focus on optimizing comorbidities to improve surgical outcomes and reduce complications. Elevated preoperative HbA1c, a marker of poor diabetes control, has been linked to adverse outcomes in open spine surgery, including infections and readmissions. Minimally invasive spine surgery (MIS) offers benefits such as reduced tissue trauma and shorter hospital stays, but the role of HbA1c optimization in MIS remains unclear. This study aimed to clarify the association between preoperative HbA1c and postoperative complications, readmissions, and length of stay in MIS lumbar spine surgery.

Data Highlights

Key Findings

• Elevated preoperative HbA1c (>7.1%) was identified as an independent predictor of increased 90-day unplanned readmissions following MIS lumbar spine surgery.
• High HbA1c was associated with higher rates of postoperative infections and wound breakdown despite the minimally invasive approach.
• Multivariate logistic regression confirmed the independent effect of elevated HbA1c after adjusting for confounders such as age, frailty, and socioeconomic status.
• Propensity score matching validated the robustness of the association between high HbA1c and adverse outcomes.
• High HbA1c did not significantly prolong hospital length of stay in this MIS cohort.

Clinical Implications

Preoperative glycemic control remains a critical factor in minimizing postoperative complications and readmissions even in minimally invasive lumbar spine surgery. Surgeons should consider optimizing HbA1c prior to elective MIS procedures to improve patient outcomes. Routine preoperative assessment of HbA1c can aid in risk stratification and perioperative planning.

Conclusion

This study highlights the importance of preoperative HbA1c optimization in minimally invasive lumbar spine surgery to reduce complications and readmissions. Despite the less invasive nature of MIS, elevated HbA1c remains a significant risk factor warranting attention in preoperative management.

References

1. STROBE Guidelines 2007 -- Strengthening the Reporting of Observational Studies in Epidemiology
2. Neighborhood Atlas 2023 -- Center for Health Disparities Research, University of Wisconsin
3. missForest Imputation Method -- Stekhoven & Bühlmann, 2012