Diabetes increases complication risk, costs following ankle fracture surgery

Diabetic patients tend to have more severe fractures and remain hospitalized one day longer than nondiabetic patients.

Compared to nondiabetic patients, patients with diabetes have significantly higher complication rates following ankle fracture surgery and have significantly higher hospitalization costs, a study by Duke University researchers confirms.

Shanti P. Ganesh, MPH, a fourth-year year medical student at Duke University School of Medicine, conducted the study with Ricardo Pietrobon, MD, PhD, and colleagues at the Duke University Medical Center in Durham, N.C. They published their results in the Journal of Bone & Joint Surgery.

“The strength of this analysis is that it provides a nationally representative and real-world picture of what happens to ankle fracture patients in the United States,” Pietrobon, senior member of the research team and director of Duke’s Center for Excellence in Surgical Outcomes, said in a press release.

“Now we have specific data that allows us to quantify the added risks and costs of diabetes for these patients. This information is crucial in improving outcomes and quality of life for our patients undergoing surgery to repair ankle fractures,” he said.

For the study, the researchers retrospectively reviewed a nationally representative sample of ankle fracture patients treated between 1988 and 2000. Patients were identified through the National Inpatient Sample database, a public database of more than 8 million patients from over 1000 U.S. hospitals, according to the study.

After excluding patients younger than 18 years of age or who had ICD-9 codes for diagnoses other than ankle fracture with subsequent surgery, the study included 160,598 patients. Of these, 9174 patients (5.71%) had diabetes.

The researchers found diabetic patients tended to be approximately 10 years older than nondiabetics. Also, significantly more diabetic patients had more severe ankle fractures (P<.001) as well as significant increases (P<.001) in the following:

in-hospital mortality;
postoperative in-hospital complications;
length of hospital stay;
nonroutine discharge rates; and
costs associated with hospital stay.

“When length of hospital stay and total charges were adjusted for fracture severity, [we] found that ... diabetic patients had approximately a one-day longer hospital stay and approximately a $2000 increase in charges across all fracture severity levels,” the authors said in the study.

Specifically, diabetic patients remained hospitalized for an average of 4.7 days while nondiabetic patients remained hospitalized for an average of 3.6 days. Regarding hospitalization costs, diabetic patients’ costs averaged 20% higher — $12,898 compared to an average of $10,794 for nondiabetic patients.

Additionally, diabetic patients had a mortality rate of 0.26% and a postop complication rate of 4.63% while nondiabetics had a mortality rate of 0.11% and a complication rate of 3.27%, according to the press release.

“When patients without diabetes were used as the referent group, patients with diabetes who had a unimalleolar, bimalleolar or trimalleolar fracture showed a significantly increased risk of both postoperative complications and nonroutine discharge. Diabetic patients with a dislocation or an open fracture showed a significantly increased risk of nonroutine discharge only,” the authors said.

The results indicate that physicians should appreciate the effect diabetes can have on the treatment and recovery of ankle fracture patients, Ganesh noted in the press release. Strategies could include close monitoring of glucose levels during and after surgery and prophylactic medication use to prevent deep venous thrombosis, she added.

For more information:
Ganesh SP, Pietrobon R, Cecilio WAC, et al. The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am. 2005;87-A:1712-1718.