Browsing by Subject "Fracture Fixation, Internal"
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Item Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus(2018-01-23) Liu, Jennifer W.; Ahn, Junho; Wukich, DaneBACKGROUND: Ankle fractures are amongst the most common type of fracture injury in adults with an annual incidence of 187 fractures per 100,000 people in the United States. Previous groups have shown that diabetes mellitus is associated with a myriad of complications - including infection, malunion, and impaired wound healing - following open reduction internal fixation (ORIF) surgery for ankle fractures. However, to our knowledge there has not been a large-scale nationwide study on the rate of readmission, reoperation, and mortality associated with diabetes. The purpose of this study was to calculate the increased risk and odds ratios for 30-day postoperative readmission, reoperation, and mortality after ankle fracture ORIF. METHODS: Patients who underwent ORIF for ankle fractures from 2006 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology codes. 30-day postoperative unplanned readmission, unplanned reoperation, and mortality rates were compared in 2,044 patients with diabetes and 15,420 patients without diabetes. Odds ratios (OR) with a 95% confidence interval (CI) were calculated for each parameter. RESULTS: Out of 17,464 patients that underwent ORIF for ankle fractures, the mean age was 47.9 +/- 17.7 years, obesity (BMI ≥30 kg/m²) was documented in 38.6% of cases, and diabetes that was severe enough to require oral, non-insulin, or insulin therapy was documented in 11.7% of cases. We found that patients with diabetes mellitus had a 2.87 times increased risk of unplanned readmission (OR, 2.87; 95% CI, 2.07-6.23; p = 0.0001) and 3.30 increased risk of unplanned reoperation (OR, 3.30; 95% CI, 2.35-7.54; p = 0.0001) related to the principal operative procedure. Additionally, patients with diabetes had a 2.01 increased risk of mortality (OR, 2.01; 95% CI, 1.08-3.62; p = 0.0377) within 30 days post operation. CONCLUSIONS: Presence of diabetes mellitus increases the risk of unplanned readmission, unplanned reoperation, and mortality after ankle fracture ORIF. Further research in optimization of perioperative care for diabetic patients is crucial to reducing rates of complications and readmission. Large clinical databases including ACS-NSQIP should endeavor to collect more parameters on diabetic patients to facilitate these studies.Item Risk Factors for Surgical Site Infection in Distal Radius Fracture Surgery(2020-05-01T05:00:00.000Z) Davis, Justin Joe; Zhang, Andrew; Sammer, Douglas; Koehler, DanielPURPOSE: Surgical site infections (SSI) after distal radius surgery can introduce substantial morbidity and additional direct and indirect costs. The clearest risk factors for SSI are the use of externalized Kirschner wires (K-wires) or external fixation (ex-fix). The roles of other potential risk factors such as open injuries, diabetes mellitus, and tobacco use are less clear. The purpose of this study was to identify independent risk factors for SSI in distal radius surgery. METHODS: A retrospective study of 541 operative distal radius fractures over a 5-year period was performed. Potential risk factors for infection included surgery duration, externalized K-wires or ex-fix, diabetes mellitus, uncontrolled diabetes defined as a HgBA1c >7 documented within a 90-day perioperative period, open fracture, tobacco use, osteoporosis, gender, and age. A screening bivariate logistic regression was performed, followed by a multiple logistic regression of the selected independent variables, with SSI as the dependent variable. A p-value of <0.05 was considered statistically significant. RESULTS: Twenty fractures (3.7%) were complicated by post-operative SSI, and 521 (96.3%) were not. Uncontrolled diabetes with HgA1c >7 (OR = 7.83, p=0.002), the presence of an ex-fix or k-wires (OR =3.73, p=0.007), and tobacco use (OR=3.79, p=0.007) were significant independent predictors of SSI. Of note, while uncontrolled diabetes was an independent risk factor, the diagnosis of diabetes alone was not. CONCLUSIONS: Previously identified risk factors for SSI after distal radius surgery including the presence of externalized K-wires or ex-fix were confirmed in this study. Additionally, this study demonstrates that tobacco use and uncontrolled diabetes (HgA1c >7) are both independent risks factors for SSI. Notably, the presence of diabetes alone was not an independent risk factor, highlighting the importance of glycemic control. LEVEL OF EVIDENCE: Level III