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Influence of diabetes mellitus on patients with lumbar spinal stenosis: A nationwide population-based study

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Author(s)
Chang Kyu LeeSun Kyu ChoiDong Ah ShinSeong YiYoon HaKeung Nyun KimInsoo Kim
Keimyung Author(s)
Lee, Chang KyuKim, In Soo
Department
Dept. of Neurosurgery (신경외과학)
Journal Title
PLoS One
Issued Date
2019
Volume
14
Issue
3
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.
Keimyung Author(s)(Kor)
이창규
김인수
Publisher
School of Medicine (의과대학)
Citation
Chang Kyu Lee et al. (2019). Influence of diabetes mellitus on patients with lumbar spinal stenosis: A nationwide population-based study. PLoS One, 14(3), e0213858–e0213858. doi: 10.1371/journal.pone.0213858
Type
Article
ISSN
1932-6203
Source
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213858
DOI
10.1371/journal.pone.0213858
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41956
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학)
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