The Influence of Diabetes Mellitus on Ankle Fracture Treatment

Abstract

Category: Trauma Introduction/Purpose: Diabetes mellitus is an epidemic affecting millions of individuals in the United States. This presents a challenging clinical problem from a surgical perspective, because of concerns for postoperative complications, including delayed wound healing, infection or compromise of fixation/repair constructs. The goal of this paper was to retrospectively review outcomes data from the American College of Surgeons: National Surgical Quality Improvement Program (ACS-NSQIP) to delineate more clearly the impact that diabetes has on operative treatment of ankle fractures, including bimalleolar and lateral malleolar injuries. Methods: Patients were identified from the 2006-2015 ACS-NSQIP database. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. A multivariate logistic regression model was created to identify independent risk factors for complications. Odds ratios were computed at the 95% confidence interval. Results: There were a total of 3745 (bimalleolar injuries [1579], lateral malleolar injuries [2166]) patients identified. With regard to treatment of distal fibular or bimalleolar injuries, diabetic patients were more likely to have a longer length of hospital stay (p < 0.05). Based on multivariate analysis, diabetic patients undergoing operative fixation of bimalleolar injuries are at higher risk for superficial incisional surgical site infection (SSI) (OR 3.26; p=0.01), any complication (OR 1.73; p<0.001), myocardial infarction (OR 10.89; p=0.046), and readmission (OR 2.38; p=0.01). In the setting of lateral malleolar fracture operative fixation, diabetic patients were at higher risk for any complication (OR 2.48; p=0.002), return to OR for unexpected complications (OR 5.88; p<0.001), and urinary tract infection (OR 4.72; p=0.03) Conclusion: Based on upon the results of this study, diabetic patients are at higher risk for postoperative complications after ankle fracture fixation, namely infection and re-operation and readmission to the hospital within 30 days after surgery. This information can help clinicians guide patients appropriately prior to surgery.