Studies have shown patients with diabetes who have poorly controlled blood sugar are more likely to have more adverse outcomes after elective surgery.

At the same time, patients do not want to wait for spine surgery. Waiting means prolonging their pain, disability and immobility — and results in significant patient dissatisfaction.

To improve surgical outcomes and minimize delays, an endocrinology-based, fast-track glucose optimization program can help patients with poorly controlled diabetes mellitus meet pre-surgery goals set by the Norton Leatherman Spine surgery team. This program is a partnership of Norton Leatherman Spine, Norton Community Medical Associates – Endocrinology and Wendy Novak Diabetes Institute, a part of Norton Healthcare.

The fast-track glucose optimization program, in collaboration with Norton Leatherman Spine, includes counseling, education and medical management for diabetes with specialists from Wendy Novak Diabetes Institute. The focus is on lowering A1C level, a modifiable risk factor. This has shown to reduce the chances of complications during and after surgery. A lower A1C is especially important if patients have other, nonmodifiable risk factors such as age, past medical history and operative invasiveness.

For example, one meta-analysis found a strong association between poorly controlled blood sugar and surgical site infection. Additional risks of surgery in these patients include slow or poor wound healing, kidney issues, heart or lung issues, neurological complications, stroke, and post-surgical death.

The fast-track program works by first identifying patients with uncontrolled diabetes.  Patients seeking elective spine surgery with an A1C level greater than 7 are referred to the program.

In the program, patients will work with an endocrinology nurse navigator, registered dietitian/certified diabetes care and education specialist, and an endocrinology provider from Wendy Novak Diabetes Institute. During their first visit with the endocrinology provider, they will review their care plan and current treatment strategies. Patients then work with the dietitian/diabetes specialist weekly to reduce blood sugar levels through diet, exercise and changes to medication regimens.

Patients who do well in the fast-track program and are able to get their hemoglobin A1C below 7 are scheduled for surgery sooner than those who do not participate. For almost all patients, surgery is scheduled less than eight weeks after starting the program.

The goal is to avoid complications, improve patient recovery times and avoid need for future surgeries.

More than 160 surgical patients successfully reached their A1C goal with the program, most of them coming from Norton Leatherman Spine. The result has been shorter hospital stays, lower costs and better results — improving patient experience and outcomes at the same time.

As a sign of the program’s efficacy, a study led by Charles H. Crawford III, M.D., orthopedic spine surgeon with Norton Leatherman Spine, and published in the Journal of the American Academy of Orthopaedic Surgeons found patients’ improved blood sugar control was maintained at follow-up.

This collaborative fast-track program is just one of the ways we set ourselves apart at Norton Leatherman Spine and Norton Healthcare, an Advanced Orthopedic & Spine Center of Excellence recognized by DNV. This designation is earned by achieving certification in at least three orthopedic service line programs and is based on guidelines, recommendations and practices recognized by the American Academy of Orthopaedic Surgeons.

At Norton Leatherman Spine, we have a multidisciplinary team with more than 45 specialists able to offer the latest in treatment options. At the same time, we are always looking for new and innovative ways — like the fast-track program — to improve both outcomes and the patient experience.

Just imagine what your help can do

Care at Norton Leatherman Spine and Wendy Novak Diabetes Institute is made possible by gifts to the Norton Healthcare Foundation from individuals, groups and foundations. Learn how you can be a part of these important programs.

Mladen Djurasovic, M.D., is an orthopedic spine surgeon with Norton Leatherman Spine.