970 The Effect of Diabetes on the Fusion Rate of Spinal Fusion Surgery: A Comprehensive Systematic Review and Meta-Analysis

Aim Spinal fusion surgeries address back pain by limiting intervertebral movement, but pseudarthrosis, a frequent complication, necessitates further interventions. Diabetes mellitus, known for impairing bone health, may negatively impact fusion rates. This systematic review and meta-analysis were carried out to assess the relationship between diabetes and spinal fusion failure. Method A comprehensive literature search was conducted on Cochrane Library, Embase, PubMed, and Web of Science databases for case-control and cohort studies examining the effect of diabetes on the fusion rate of spinal fusion surgery. Data was extracted based on the pre-defined inclusion and exclusion criteria. The Review Manager software, version 5.4, was used to perform all statistical analysis. Results Nine studies with 2117 patients were included in the meta-analysis. The pooled odds ratio from nine studies was 0.53 (95% confidence interval 0.37-0.77, P = 0.0008), indicating a significantly lower fusion rate in diabetics. Stratifying studies by operative site showed a non-significant odds ratio for cervical but significant for lumbar. Stratification by graft type revealed a significant odds ratio for autograft and a non-significant odds ratio for allograft/synthetic. Conclusions The findings of this study suggest that diabetes could be a risk factor for fusion failure in spinal fusion surgeries. A comprehensive understanding of the role diabetes plays in fusion rates may help refine preoperative risk assessments and patient selection, potentially leading to improved surgical outcomes. This evidence highlights the necessity for further investigations and developing more effective strategies for diabetic patients undergoing spinal fusion.