Medical Student, University of Texas Southwestern Medical Center, Dallas, TX.
Resident, Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
J Foot Ankle Surg. 2021 Sep-Oct;60(5):917-922. doi: 10.1053/j.jfas.2021.03.011. Epub 2021 Mar 20.
Patients with diabetes mellitus that undergo ankle fracture surgery have higher rates of postoperative complications compared to patients without diabetes mellitus. We evaluated the rate of complications in insulin-dependent diabetes mellitus patients, non-insulin-dependent diabetes mellitus patients, and patients without diabetes in the 30-day postoperative period following ankle fracture surgery. We also analyzed hospital length of stay, unplanned readmission, unplanned reoperation, and death. Patients who underwent operative management for ankle fractures between 2012 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program® database using Current Procedural Terminology codes. Multiple logistic regression was implemented. Adjusted odds ratios were calculated along with the 95% confidence interval. A total of 19,547 patients undergoing ankle surgery were identified from 2012 to 2016. Of these patients, 989 (5.06%) had insulin-dependent diabetes mellitus, 1256 (6.43%) had noninsulin-dependent diabetes mellitus, and 17,302 (88.51%) did not have diabetes mellitus. Compared to patients without diabetes, patients with insulin-dependent diabetes mellitus had significantly greater adjusted odds of superficial surgical site infections, deep surgical site infections, osteomyelitis, wound dehiscence, pneumonia, unplanned intubation, mechanical ventilation, urinary tract infection, cardiac arrest, bleeding requiring transfusion, sepsis, hospital length of stay, unplanned readmission, unplanned reoperation, and death following ankle fracture surgery. We demonstrate that insulin-dependent diabetes mellitus is a strong predictor of 30-day postoperative complications, unplanned readmission, unplanned reoperation, and death following ankle fracture surgery.
患有糖尿病的踝关节骨折手术患者术后并发症发生率高于非糖尿病患者。我们评估了胰岛素依赖型糖尿病、非胰岛素依赖型糖尿病和无糖尿病患者在踝关节骨折手术后 30 天内的并发症发生率。我们还分析了住院时间、非计划再入院、非计划再次手术和死亡。2012 年至 2016 年期间，我们在美国外科医师学会国家手术质量改进计划数据库中使用当前程序术语代码确定了接受踝关节骨折手术治疗的患者。实施了多变量逻辑回归。计算了调整后的优势比及其 95%置信区间。2012 年至 2016 年期间共确定了 19547 例接受踝关节手术的患者。这些患者中，989 例（5.06%）患有胰岛素依赖型糖尿病，1256 例（6.43%）患有非胰岛素依赖型糖尿病，17302 例（88.51%）无糖尿病。与无糖尿病患者相比，胰岛素依赖型糖尿病患者发生浅表手术部位感染、深部手术部位感染、骨髓炎、伤口裂开、肺炎、计划外插管、机械通气、尿路感染、心脏骤停、需要输血的出血、败血症、住院时间、计划外再入院、计划外再次手术和踝关节骨折手术后死亡的调整优势比显著更高。我们证明，胰岛素依赖型糖尿病是踝关节骨折手术后 30 天内术后并发症、非计划再入院、非计划再次手术和死亡的强有力预测因素。
