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Influence of diabetes mellitus on patients with lumbar spinal stenosis: A nationwide population-based study.
PLOS ONE ( IF 3.7 ) Pub Date : 2019-03-15 , DOI: 10.1371/journal.pone.0213858
Chang Kyu Lee 1, 2 , Sun Kyu Choi 3 , Dong Ah Shin 2 , Seong Yi 2 , Yoon Ha 2 , Keung Nyun Kim 2 , Insoo Kim 1
Affiliation  

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.

中文翻译:

糖尿病对腰椎管狭窄症患者的影响:一项基于全国的人口研究。

目的评估腰椎管狭窄症(LSS)和糖尿病(DM)患者合并症,医疗费用和手术结局之间的关系。方法2005年至2007年,从韩国国民健康保险服务数据库中收集了LSS患者(n = 14,298)的数据。经过8年的随访,“ DM组”(n = 3,478)和“非DM组”根据结局指标比较“组”(n = 10,820)。进行Cox比例风险回归分析以检查DM,高血压(HTN),心血管疾病(CVD),慢性肾脏病(CKD),脑血管疾病(CbVD)和LSS手术之间的关系。在DM和LSS患者中,还评估了接受腰椎手术的患者的入院率,医疗费用以及总生存率。结果DM组的死亡率比非DM组高约1.35倍。患有DM和合并症的患者包括HTN(危险比[HR]为1.40; 95%置信区间[CI]为1.25-1.56; p <0.001),CVD(HR为1.53; 95%CI为1.36-1.73; p <0.001 ),CKD(HR,3.18; 95%CI,2.7-3.76; p <0.001)和CbVD(HR,1.69; 95%CI,1.49-1.91; p <0.001)显示死亡风险增加。腰椎手术的DM患者的平均住院时间和平均医疗费用分别为60.8天和7,127美元。这比接受LSS保守治疗的DM患者分别延长了31.3天和6,207美元。在DM组中,与保守治疗相比,LSS手术治疗的生存率具有明显的阳性预后趋势(p = 0.046)。结论在LSS患者中,DM与预后不良(在CKD患者中最明显)以及手术患者的医疗费用增加有关。然而,与保守治疗相比,DM患者LSS的外科治疗与预后良好有关。
更新日期:2019-03-17
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