Ganesh Shanti P, Pietrobon Ricardo, Cecílio William A C, Pan Deng, Lightdale Nina, Nunley James A
Duke University Medical Center, Durham, North Carolina 27707, USA.
J Bone Joint Surg Am. 2005 Aug;87(8):1712-8. doi: 10.2106/JBJS.D.02625.
Ankle fracture is one of the most common injuries treated by orthopaedic surgeons, and the presence of diabetes complicates treatment and recovery from this injury. Although a higher prevalence of adverse postoperative events has been found in small series of diabetic patients with an ankle fracture, we are not aware of any large national series with specific documentation of the outcomes following ankle fracture in patients with diabetes.
We analyzed data from the Nationwide Inpatient Sample database for the years 1988 through 2000. Information regarding the hospitalizations of 160,598 adult patients with an ankle fracture who underwent subsequent surgical procedures was extracted from the database. Multiple linear and logistic regression models were used to ascertain whether patients with diabetes mellitus were more likely than patients without diabetes mellitus to die while in the hospital, to have in-hospital postoperative complications, to stay longer in the hospital, to have a higher incidence of non-routine discharge, and to have a higher total cost associated with the hospital stay.
Significant increases in in-hospital mortality, the rate of in-hospital postoperative complications, the length of hospital stay, the rate of non-routine discharge, and the total charges were found in the diabetic patient group (p < 0.001). Specifically, we found that diabetic patients across all levels of fracture severity (closed unimalleolar, closed bimalleolar or trimalleolar, and dislocated or open fractures) stayed in the hospital for about one additional day (mean, 4.7 compared with 3.6 days) and incurred more than dollar 2000 in increased charges (mean, dollar 12,898 compared with dollar 10,794).
This nationally representative study of inpatients in the United States provides evidence that diabetic patients with an operatively treated ankle fracture are likely to have worse results than non-diabetic patients with regard to postoperative complications, mortality, rate of non-routine discharge, length of hospital stay, and total hospital charges.
踝关节骨折是骨科医生治疗的最常见损伤之一，而糖尿病的存在使该损伤的治疗和恢复变得复杂。尽管在少数患有踝关节骨折的糖尿病患者系列研究中发现术后不良事件的发生率较高，但我们并不知晓有任何大型全国性系列研究专门记录了糖尿病患者踝关节骨折后的治疗结果。
我们分析了1988年至2000年全国住院患者样本数据库中的数据。从该数据库中提取了160598例接受后续手术治疗的成年踝关节骨折患者的住院信息。使用多元线性和逻辑回归模型来确定糖尿病患者是否比非糖尿病患者更有可能在住院期间死亡、发生术后并发症、住院时间更长、非常规出院发生率更高以及住院总费用更高。
糖尿病患者组在住院死亡率、术后并发症发生率、住院时间、非常规出院率和总费用方面均有显著增加（p < 0.001）。具体而言，我们发现所有骨折严重程度（闭合单踝骨折、闭合双踝或三踝骨折以及脱位或开放性骨折）的糖尿病患者住院时间大约多一天（平均，4.7天对比3.6天），费用增加超过2000美元（平均，12898美元对比10794美元）。
这项针对美国住院患者的具有全国代表性的研究提供了证据，表明接受手术治疗的踝关节骨折糖尿病患者在术后并发症、死亡率、非常规出院率、住院时间和住院总费用方面可能比非糖尿病患者的结果更差。
