Background: 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.
Methods: 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.
Results: 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 $2000 in increased charges (mean, $12,898 compared with
Conclusions: 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
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.