Risk of Hospital-Acquired Conditions Is Higher in Spine Patients With Diabetes and Hypertension

Patient frailty is associated with higher prevalence of certain hospital-acquired conditions (HACs) in patients undergoing elective spine surgery, and a study has found that hypertension and diabetes increase risk of frailty. Results from this study were presented at the AAOS 2021 Annual Meeting by Peter G. Passias, MD, of New York University Langone Health.

In this analysis, Dr. Passias and coauthors evaluated the effects of “modifiable” patient factors on HAC risk in nearly 200,000 patients who underwent spine surgery between 2005 and 2016.

Average age in the study population was 57 years, and the cohort was 48% female. Frailty scores were calculated using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) five-factor frailty index. Frailty ratings across the cohort were:

• No frailty: 83.6%
• Moderate frailty: 15.1%
• Severe frailty: 1.3%

Overall, 2.9% of patients developed HACs, the most common of which were surgical site infection (SSI; 1.3%) and urinary tract infection (UTI; 1.1%). HAC rates according to frailty ratings were:

• No frailty: 2.64%
• Moderate frailty: 4.17%
• Severe frailty: 5.93%

Patients with moderate or severe frailty had a statistically higher prevalence of HACs, compared to patients with no frailty.

When the authors performed a stepwise regression analysis for predictors of higher baseline frailty, they found that diabetes and hypertension were most closely associated with more severe frailty. Next, looking at patients without these factors, they observed a significantly lower incidence of HACs among those without diabetes or hypertension (2.18% vs. 3.56%). This included lower incidence of SSI (2.03% vs. 2.5%), UTI (0.65% vs. 1.4%), and deep vein thrombosis (0.56% vs. 0.84%).