Bramian Allen, Ling Kenny, Butsenko Dmitriy, Komatsu David, Wang Edward
Stony Brook University Hospital, Stony Brook, USA.
Eur J Orthop Surg Traumatol. 2025 Jan 22;35(1):56. doi: 10.1007/s00590-025-04173-z.
Diabetes mellitus (DM) is a well-established risk factor for postoperative complications. Distal radius fractures (DRFs) are a common orthopedic injury and often require open reduction and internal fixation (ORIF). The rise of ORIF utilization warrants investigation into factors that may expose patients to postoperative complications following DRF ORIF.
We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for cases of DRF ORIF between 2015 and 2021. Cases were stratified into cohorts based on diabetes mellitus (DM) status. The DM cohort was further stratified into non-insulin-dependent DM (NIDDM) and insulin-dependent DM (IDDM) groups. Bivariate logistic regression was performed to compare patient demographics, comorbidities, and 30-day postoperative complications. Multivariate logistic regressions were performed to identify associations between diabetes mellitus status and postoperative complications.
A total of 27,761 cases of DRF ORIF were identified from 2015 to 2021. After exclusion criteria were applied, 25,971 cases remained, of which 2169 (8.4%) cases had DM and 23,802 (91.6%) cases were free of DM. Within the DM cohort, there were 1392 cases in the NIDDM subgroup and 777 cases in the IDDM subgroup. Relative to the cohort without diabetes, the IDDM cohort was independently associated with sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off mechanical ventilation, readmission, and nonhome discharge.
Having IDDM was independently associated with higher rates of postoperative sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off ventilation, readmission, and nonhome discharge when compared to the cohort without diabetes following DRF ORIF.
Level III; Retrospective cohort comparison; Prognosis study.
糖尿病（DM）是术后并发症公认的危险因素。桡骨远端骨折（DRF）是常见的骨科损伤，常需切开复位内固定术（ORIF）。ORIF应用的增加促使人们对可能使患者在DRF ORIF术后面临并发症的因素进行调查。
我们查询了美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库中2015年至2021年期间DRF ORIF的病例。根据糖尿病（DM）状态将病例分层为队列。DM队列进一步分为非胰岛素依赖型糖尿病（NIDDM）和胰岛素依赖型糖尿病（IDDM）组。进行双变量逻辑回归以比较患者人口统计学、合并症和术后30天并发症。进行多变量逻辑回归以确定糖尿病状态与术后并发症之间的关联。
2015年至2021年共确定27761例DRF ORIF病例。应用排除标准后，剩余25971例，其中2169例（8.4%）患有DM，23802例（91.6%）无DM。在DM队列中，NIDDM亚组有1392例，IDDM亚组有777例。与无糖尿病队列相比，IDDM队列与脓毒症、感染性休克、再次插管、心肌梗死、输血、无法脱机机械通气、再次入院和非家庭出院独立相关。
与DRF ORIF术后无糖尿病的队列相比，患有IDDM与术后脓毒症、感染性休克、再次插管、心肌梗死、输血、无法脱机通气、再次入院和非家庭出院的发生率较高独立相关。
III级；回顾性队列比较；预后研究。
