• Gonzalo Mariscal, Rick C Sasso, John E O'Toole, Christopher D Chaput, Michael P Steinmetz, Paul M Arnold, Christopher D Witiw, W Bradley Jacobs, and James S Harrop.
• Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain. Gonzalo.Mariscal@mail.ucv.es.
• Eur Spine J. 2025 Jan 3.

PurposeThis study aimed at comparing the costs of spinal fusion surgery between patients with and without diabetes.MethodsFollowing 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.ResultsTwenty-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).ConclusionPatients with diabetes undergoing spinal fusion surgery had increased costs, prolonged LOS, increased 30-day/90-day readmission rates, and more frequent non-routine discharges.© 2024. The Author(s).

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