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Influence of Diabetes Mellitus on Patients With Lumbar Spinal Stenosis: A Nationwide Population-Based Study

Authors
 Chang Kyu Lee  ;  Sun Kyu Choi  ;  Dong Ah Shin  ;  Seong Yi  ;  Yoon Ha  ;  Keung Nyun Kim  ;  Insoo Kim 
Citation
 PLOS ONE, Vol.14(3) : e0213858, 2019-03 
Journal Title
 PLOS ONE 
Issue Date
2019-03
MeSH
Aged ; Comorbidity ; Diabetes Mellitus / physiopathology* ; Female ; Humans ; Lumbar Vertebrae / surgery* ; Male ; Middle Aged ; Postoperative Complications* ; Prognosis ; Republic of Korea / epidemiology ; Spinal Stenosis / epidemiology ; Spinal Stenosis / mortality* ; Spinal Stenosis / surgery ; Survival Rate
Abstract
Purpose: To evaluate the relationship between comorbidities, medical cost, and surgical outcome in patients with lumbar spinal stenosis (LSS) and diabetes mellitus (DM). Methods: Data on patients with LSS (n = 14,298) were collected from the Korean National Health Insurance Service database from 2005 to 2007. After 8 years of follow-up, a "DM group" (n = 3,478) and a "non-DM group" (n = 10,820) were compared according to outcome measures. Cox proportional hazard regressions were performed to examine the relationship between DM, hypertension (HTN), cardiovascular disease (CVD), chronic kidney disease (CKD), cerebrovascular disease (CbVD), and surgery for LSS. The admission rate and medical cost as well asthe overall survival rate for those who underwent lumbar surgery were also assessed among patients with DM and LSS. Results: Mortality was about 1.35 times higher in the DM group than in the non-DM group. Patients with DM and comorbidities including HTN (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.25-1.56; p<0.001), CVD (HR, 1.53; 95% CI, 1.36-1.73; p<0.001), CKD (HR, 3.18; 95% CI, 2.7-3.76; p<0.001), and CbVD (HR, 1.69; 95% CI, 1.49-1.91; p<0.001) showed an increased risk of mortality. The mean hospitalization time and average medical cost of patients with DM who underwent lumbar surgery were 60.8 days, and 7,127 USD, respectively. This was 31.3 days longer, and 6,207 USD higher, respectively, than those of patients with DM who underwent conservative treatment for LSS. Within the DM group, the survival rate of surgical management of LSS had a significant tendency for positive prognosis compared with those administered conservative treatment (p = 0.046). Conclusions: In patients with LSS, DM was associated both with poor prognosis (most significantly in those with CKD), and increased medical cost in those who underwent surgery. Nevertheless, surgical treatment for LSS in patients with DM was related to favorable prognosis compared with conservative treatment.
Files in This Item:
T201906306.pdf Download
DOI
10.1371/journal.pone.0213858
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Keung Nyun(김긍년)
Shin, Dong Ah(신동아) ORCID logo https://orcid.org/0000-0002-5225-4083
Yi, Seong(이성)
Ha, Yoon(하윤)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175886
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