Endocrinology fast-track program may optimize patients for spine surgery
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CHICAGO — Implementation of an endocrinology fast-track program may allow patients with poorly controlled diabetes to successfully obtain acceptable blood sugar control prior to spine surgery, according to results presented here.
“Our conclusions were that [an endocrinology fast-track program] was a good addition to our system, that we were successful at getting patients optimized for surgery and it seems that the benefit is for those patients that do not already have a well-established health care team,” Charles H. Crawford, MD, said in his presentation at the North American Spine Society Annual Meeting. “If they already have a good relationship with their primary care doctor, their endocrinologist, they probably do not need this program. But if they don’t have access to care, this program was helpful to be able to get those patients to surgery.”
Among 75 patients with a hemoglobin A1c greater than 7% scheduled for elective lumbar fusion surgery, Crawford and colleagues found 43% accepted referral to an endocrinology fast-track program. Patients who accepted referral to the fast-track program underwent initial labs, had an endocrinology consult with a health care provider, met with a diabetic educator and received weekly check-ins on the phone.
“If it seemed like they were making good progress at 2 weeks in following through with the program and documenting their glucose at home, making the changes to their diet and the medications that were recommended, we went ahead and gave them a surgery date 4 weeks later,” Crawford said.
A week prior to surgery, researchers collected fructosamine levels from patients. Patients with a fructosamine level that was equivalent to a hemoglobin A1c of less than 7% were cleared for surgery, according to Crawford.
“If you accepted referral to the fast-track program, you had a 91% chance that you obtained that clearance lab value for surgery, whereas only 42% of our patients who declined the fast-track program ended up getting cleared and having surgery,” Crawford said.
Crawford noted patients who declined participation in the fast-track program maintained improved blood glucose control postoperatively. He added patients who were current smokers were more likely to decline referral to the fast-track program.
“Looking at patients who obtained surgical clearance, whether they did the fast-track program or whether they obtained that better glucose control with their established primary care provider, established endocrinologist, the good news is that in both groups, at follow-up, their blood glucose control was better than it was preoperatively,” Crawford said.
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Crawford CH, et al. Paper 110. Presented at: North American Spine Society Annual Meeting; Oct. 12-15, 2022; Chicago.
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