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. 2025 Apr 28;14(9):3039.
doi: 10.3390/jcm14093039.

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

David Maman  1   2 , Assil Mahamid  3 , Gabriel Nisanov  2 , Oluwaseun Fagbamila  4 , Ali Sleiman  1   2 , Arsen Shpigelman  1   2 , Yaron Berkovich  1   2
Affiliations

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

David Maman et al. J Clin Med. .

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.

Keywords: anterior cervical discectomy and fusion; healthcare costs; length of stay; postoperative complications; type 2 diabetes.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Risk ratios for general postoperative complications in single-level ACDF patients with type II diabetes compared to non-diabetic patients.
Figure 2
Figure 2
Risk ratios for ACDF-specific complications in single-level ACDF patients with type II diabetes compared to non-diabetic patients.
See this image and copyright information in PMC

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