# The Impact of Diabetes on Outcomes in Anterior Cervical Discectomy and Fusion (ACDF)

## TL;DR

This study shows that type 2 diabetes increases complications, hospital stays, and costs after cervical spine surgery.

## Contribution

The study uses a large national database and propensity score matching to quantify diabetes-related risks in ACDF patients.

## Key findings

- Diabetic patients had higher risks of ACDF-specific complications like cerebrospinal fluid leaks and spinal cord injury.
- General complications such as sepsis, stroke, and heart failure were also significantly more common in diabetic patients.
- Diabetic patients had longer hospital stays and higher hospital charges compared to non-diabetic patients.

## Abstract

Background: Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical radiculopathy and myelopathy. While generally effective, diabetes mellitus may increase postoperative complications and healthcare costs. This study evaluated the impact of type 2 diabetes on perioperative outcomes in ACDF patients. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016–2019), including 85,585 single-level ACDF patients. Propensity score matching (PSM) was applied, creating two balanced cohorts (16,260 diabetic and 16,260 non-diabetic patients). Outcomes analyzed included postoperative complications, length of stay, hospital charges, and mortality. Results: Diabetic patients had significantly higher risks of ACDF-specific complications, including cerebrospinal fluid leaks (2×), dysphagia (2.5×), dysphonia (2.9×), and cervical spinal cord injury (5×). General complications were also increased, with higher rates of pulmonary embolism (2.4×), sepsis (3×), stroke (3×), pneumonia (3.3×), and heart failure (12×). Diabetic patients had longer hospital stays (1.99 vs. 1.79 days, p < 0.001) and higher hospital charges (USD 71,884 vs. USD 67,998, p = 0.004). Conclusions: T2DM significantly increases postoperative risks, length of stay, and costs for ACDF patients. Optimized perioperative management and glucose control are essential to improve outcomes in this high-risk population.