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Peer-reviewedCC BY 4.0PLOS One

Association of type 2 diabetes mellitus with postoperative outcomes following single-level endoscopic lumbar interbody fusion through a posterior approach: A global propensity score–matched cohort study

  • Phuoc Giau Dang1
  • Yu-Pin Chen2
  • Tan Thanh Nguyen3
  • Dat Huu Nguyen4
  • Yi-Jie Kuo5
5 affiliations
  1. 1The International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  2. 2Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
  3. 3Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  4. 4Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  5. 5Department of Orthopedic Surgery, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
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Abstract

Background: Type 2 diabetes mellitus (T2DM) has been associated with impaired bone healing and may increase the risk of pseudarthrosis after lumbar fusion. Its impact after endoscopic lumbar interbody fusion (Endo-LIF) performed through a posterior approach remains unclear. Methods: In this retrospective cohort study using the TriNetX Global Collaborative Network, adults undergoing single-level Endo-LIF through a posterior approach between 2015 and 2025 were identified from ICD-10-PCS procedure codes, which record a percutaneous endoscopic interbody fusion approached from behind but do not distinguish uniportal from biportal technique or posterior from transforaminal variants. Patients with and without T2DM were propensity score–matched 1:1 on demographic and clinical variables. The primary outcome was code-defined pseudarthrosis (ICD-10-CM M96.0) within three years; secondary outcomes were 90-day complications and one-year healthcare utilization. Time-to-event outcomes were analyzed with Kaplan–Meier estimates, log-rank tests and Cox regression. Results: After matching, 755 patients remained per cohort. Early complications and healthcare utilization were comparable (all p > 0.05). Code-defined pseudarthrosis was recorded more often with T2DM at every interval (observed proportions 11.5% vs 6.2% by 36 months; all p < 0.01). Kaplan–Meier cumulative incidence at 36 months was 12.0% (95% CI 9.8–14.6) with T2DM versus 6.4% (95% CI 4.9–8.5) without (log-rank p = 0.0003), an absolute risk difference of 5.5% (95% CI 2.6% to 8.5%); the hazard ratio was 1.90 (95% CI 1.33–2.71). Conclusion: In this database cohort, T2DM was associated with a higher rate of code-defined pseudarthrosis after single-level Endo-LIF, despite similar short-term outcomes. Because the outcome was code-defined and the procedure codes do not characterize operative technique, these findings describe an association only: they do not establish that T2DM independently causes radiographic nonunion, and are consistent with, but do not demonstrate, a contribution of systemic metabolic factors to long-term fusion.

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Cite

BibTeXRIS
BibTeX
@article{dang2026association,
  title = {{Association of type 2 diabetes mellitus with postoperative outcomes following single-level endoscopic lumbar interbody fusion through a posterior approach: A global propensity score–matched cohort study}},
  author = {Phuoc Giau Dang and Yu-Pin Chen and Tan Thanh Nguyen and Dat Huu Nguyen and Yi-Jie Kuo},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0358422},
  url = {https://doi.org/10.1371/journal.pone.0358422},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association of type 2 diabetes mellitus with postoperative outcomes following single-level endoscopic lumbar interbody fusion through a posterior approach: A global propensity score–matched cohort study
AU  - Phuoc Giau Dang
AU  - Yu-Pin Chen
AU  - Tan Thanh Nguyen
AU  - Dat Huu Nguyen
AU  - Yi-Jie Kuo
PY  - 2026
DA  - 2026/09/18
JO  - PLOS One
DO  - 10.1371/journal.pone.0358422
UR  - https://doi.org/10.1371/journal.pone.0358422
AB  - Background: Type 2 diabetes mellitus (T2DM) has been associated with impaired bone healing and may increase the risk of pseudarthrosis after lumbar fusion. Its impact after endoscopic lumbar interbody fusion (Endo-LIF) performed through a posterior approach remains unclear. Methods: In this retrospective cohort study using the TriNetX Global Collaborative Network, adults undergoing single-level Endo-LIF through a posterior approach between 2015 and 2025 were identified from ICD-10-PCS procedure codes, which record a percutaneous endoscopic interbody fusion approached from behind but do not distinguish uniportal from biportal technique or posterior from transforaminal variants. Patients with and without T2DM were propensity score–matched 1:1 on demographic and clinical variables. The primary outcome was code-defined pseudarthrosis (ICD-10-CM M96.0) within three years; secondary outcomes were 90-day complications and one-year healthcare utilization. Time-to-event outcomes were analyzed with Kaplan–Meier estimates, log-rank tests and Cox regression. Results: After matching, 755 patients remained per cohort. Early complications and healthcare utilization were comparable (all p > 0.05). Code-defined pseudarthrosis was recorded more often with T2DM at every interval (observed proportions 11.5% vs 6.2% by 36 months; all p < 0.01). Kaplan–Meier cumulative incidence at 36 months was 12.0% (95% CI 9.8–14.6) with T2DM versus 6.4% (95% CI 4.9–8.5) without (log-rank p = 0.0003), an absolute risk difference of 5.5% (95% CI 2.6% to 8.5%); the hazard ratio was 1.90 (95% CI 1.33–2.71). Conclusion: In this database cohort, T2DM was associated with a higher rate of code-defined pseudarthrosis after single-level Endo-LIF, despite similar short-term outcomes. Because the outcome was code-defined and the procedure codes do not characterize operative technique, these findings describe an association only: they do not establish that T2DM independently causes radiographic nonunion, and are consistent with, but do not demonstrate, a contribution of systemic metabolic factors to long-term fusion.
SN  - 1932-6203
ER  -