Date of Submission

Fall 12-9-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Jo Loomis

Second Advisor

Dr. Ricky Northwood


Executive Summary

Objective: This manuscript aims to determine if controlling diabetes prior to undergoing low back surgery could decrease complications and disability.

Contexts: Despite the overwhelming information on the complications of uncontrolled diabetes, patients continue to have elevated HgA1C before having surgery. Furthermore, there is a plethora of data showing uncontrolled diabetic patients will have higher complications after surgery, yet patients continue to have elective surgery despite having unchecked diabetes. There are no clear guidelines for primary care providers or surgeons on when they should allow patients to have elective surgery. Therefore, it is vital that HgA1c needs to be assessed by primary care providers as a routine part of the medical clearance process.

Intervention: An educational program consisting of pamphlets, videos, and PowerPoints will be directed to primary care physicians and family nurse practitioners to educate them on surgical complications of uncontrolled diabetes. Second, the importance of utilizing HgA1c < 7 as part of medical clearance should be implemented.

Outcomes: The tool to measure results to be measured will be a post-education survey to be completed by PCPs and FNPs. In addition, the Oswestry low back pain disability questionnaire will be given to PCPs and FNPs to ascertain what percentage of their patient had complications after implementing the new medical clearance guidelines. After implementing the new education program and the requirement of having HgA1C < 7, there are expected to be 20% fewer infections and complications.