Diabetic neuropathy is associated with increased long-term morbidity and revision risk following lumbar laminectomy or laminotomy

Background: Diabetic neuropathy is a common microvascular complication of diabetes and may reflect systemic vulnerability that extends beyond peripheral nerve dysfunction. Its long-term impact on postoperative outcomes following lumbar laminectomy/laminotomy remains poorly characterized. This study aimed to evaluate the association between diabetic neuropathy and long-term postoperative complications, healthcare utilization, and revision surgery following lumbar laminectomy or laminotomy. Methods: Using a nationwide federated research network, adults undergoing lumbar laminectomy or laminotomy were identified and stratified by the presence of diabetic neuropathy. One-to-one propensity score matching was performed to balance demographics, comorbidities, medications, and laboratory values. Longitudinal outcomes, including medical complications, healthcare utilization, and revision surgery, were assessed at 1, 5, and 10 years. Kaplan-Meier analysis was used to estimate revision-free survival. Results: After matching, 19,265 patients with diabetic neuropathy were compared with 19,265 patients without neuropathy. Across all time horizons, diabetic neuropathy was associated with higher rates of adverse medical outcomes, including sepsis, venous thromboembolism, myocardial infarction, and cerebral infarction. Emergency department utilization remained consistently elevated in the neuropathy cohort at 1, 5, and 10 years. Revision lumbar surgery occurred more frequently among patients with diabetic neuropathy, with differences evident early and persisting over long-term follow-up. Kaplan-Meier analysis demonstrated significantly lower revision-free survival in patients with neuropathy compared with matched controls over 10 years. Findings remained directionally consistent in a sensitivity analysis using a stricter comparator cohort restricted to patients without diabetic complications. Conclusions: In this large, propensity-matched cohort, diabetic neuropathy was associated with a sustained increase in medical complications, healthcare utilization, and revision surgery following lumbar laminectomy or laminotomy. These findings suggest that diabetic neuropathy represents a marker of long-term postoperative vulnerability rather than isolated perioperative risk and may warrant consideration in preoperative risk stratification and longitudinal care planning.