Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus

BACKGROUND: 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.