TY - JOUR
T1 - The economic burden of diabetes in spinal fusion surgery
T2 - a systematic review and meta-analysis
AU - Mariscal, Gonzalo
AU - Sasso, Rick C.
AU - O’Toole, John E.
AU - Chaput, Christopher D.
AU - Steinmetz, Michael P.
AU - Arnold, Paul M.
AU - Witiw, Christopher D.
AU - Jacobs, W. Bradley
AU - Harrop, James S.
N1 - Dr M.P. Steinmetz received royalties from Elsevier and Globus Medical, Inc. an honorarium from Globus Medical, Inc. and consulting fees from Cerapedics Inc. Dr J.S. Harrop is a scientific advisor to Johnson & Johnson, Spiderwort Inc., and Kringle Pharma, Inc. Dr C.D. Witiw received institutional research funding from the Canadian Institutes of Health Research and Cerapedics Inc., as well as speaking and consulting fees from Stryker Corp. Dr J.E. O\u2019Toole received consulting fees and royalties from Globus Medical, Inc., consulting fees from Cerapedics Inc., royalties from Medtronic plc and NuVasive, Inc. and owns stock in Viseon Inc. Dr C.D. Chaput received institutional research funding from Cerapedics Inc., Kuros Biosciences A.G., and Nuvasive, Inc. and received royalties from Globus Medical, Inc. Dr W.B. Jacobs received consulting and speaking fees from DePuy-Synthes, Inc., Stryker Corp, and Cerapedics Inc. Dr R.C. Sasso received royalties from Medtronic plc and NuVasive, Inc. Dr. G. Mariscal received consulting fees from Cerapedics Inc.
PY - 2025/1/3
Y1 - 2025/1/3
N2 - Purpose: This study aimed at comparing the costs of spinal fusion surgery between patients with and without diabetes. Methods: Following PRISMA guidelines, a systematic search of four databases was conducted. A meta-analysis was performed on comparative studies examining diabetic versus non-diabetic adults undergoing cervical/lumbar fusion in terms of cost. Heterogeneity was assessed using the I2 test. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model in the presence of heterogeneity. Results: Twenty-two studies were included in this meta-analysis. Standardized costs were significantly higher in the diabetic group (SMD 0.02, 95% CI 0.01 to 0.03, p < 0.05). The excess cost per diabetic patient undergoing spinal fusion surgery was estimated to be $2,492 (95% CI: $1,620 to $3,363). The length of stay (LOS) was significantly longer in the diabetes group (MD 0.42, 95% CI 0.24 to 0.60, p < 0.001). No significant difference was observed in intensive care unit admission between the groups (OR 4.15, 95% CI 0.55 to 31.40, p > 0.05). Reoperation showed no significant differences between the groups (OR 1.14, 95% CI 0.96 to 1.35, p > 0.05). However, 30-day and 90-day readmissions were significantly higher in the diabetes group: (OR 1.42, 95% CI 1.24 to 1.62, p < 0.05) and (OR 1.39, 95% CI 1.15 to 1.68, p < 0.001), respectively. Non-routine or non-home discharge was also significantly higher in the diabetes group (OR 1.89, 95% CI 1.67 to 2.13, p < 0.001). Conclusion: Patients with diabetes undergoing spinal fusion surgery had increased costs, prolonged LOS, increased 30-day/90-day readmission rates, and more frequent non-routine discharges.
AB - Purpose: This study aimed at comparing the costs of spinal fusion surgery between patients with and without diabetes. Methods: Following PRISMA guidelines, a systematic search of four databases was conducted. A meta-analysis was performed on comparative studies examining diabetic versus non-diabetic adults undergoing cervical/lumbar fusion in terms of cost. Heterogeneity was assessed using the I2 test. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model in the presence of heterogeneity. Results: Twenty-two studies were included in this meta-analysis. Standardized costs were significantly higher in the diabetic group (SMD 0.02, 95% CI 0.01 to 0.03, p < 0.05). The excess cost per diabetic patient undergoing spinal fusion surgery was estimated to be $2,492 (95% CI: $1,620 to $3,363). The length of stay (LOS) was significantly longer in the diabetes group (MD 0.42, 95% CI 0.24 to 0.60, p < 0.001). No significant difference was observed in intensive care unit admission between the groups (OR 4.15, 95% CI 0.55 to 31.40, p > 0.05). Reoperation showed no significant differences between the groups (OR 1.14, 95% CI 0.96 to 1.35, p > 0.05). However, 30-day and 90-day readmissions were significantly higher in the diabetes group: (OR 1.42, 95% CI 1.24 to 1.62, p < 0.05) and (OR 1.39, 95% CI 1.15 to 1.68, p < 0.001), respectively. Non-routine or non-home discharge was also significantly higher in the diabetes group (OR 1.89, 95% CI 1.67 to 2.13, p < 0.001). Conclusion: Patients with diabetes undergoing spinal fusion surgery had increased costs, prolonged LOS, increased 30-day/90-day readmission rates, and more frequent non-routine discharges.
KW - Cost analysis
KW - Diabetes
KW - Hospital costs
KW - Resource utilization
KW - Spinal fusion
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U2 - 10.1007/s00586-024-08631-w
DO - 10.1007/s00586-024-08631-w
M3 - Review article
C2 - 39751814
AN - SCOPUS:85213954002
SN - 0940-6719
JO - European Spine Journal
JF - European Spine Journal
ER -