The impact of diabetes on patient outcomes after ankle fracture
The impact of diabetes on patient outcomes after ankle fracture
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DOI：
10.2106/jbjs.d.02625
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发表时间：
2005-08-01
影响因子：
5.3
通讯作者：
Nunley, JA
中科院分区：
文献类型：
--
作者：
Ganesh, SP;Pietrobon, R;Nunley, JA
背景资料：踝关节骨折是骨科医生治疗的最常见的损伤之一，糖尿病的存在使这种损伤的治疗和恢复复杂化。虽然一个较高的患病率已被发现在小系列的糖尿病患者踝关节骨折的术后不良事件，我们不知道任何大型的国家系列与具体文件的结果踝关节骨折后糖尿病patients.Methods：我们分析了数据从全国住院病人样本数据库的1988年至2000年。从数据库中提取了160，598例踝关节骨折并接受后续手术的成年患者的住院信息。采用多元线性和逻辑回归模型确定糖尿病患者是否比非糖尿病患者更容易在住院期间死亡、发生院内术后并发症、住院时间更长、非常规出院发生率更高以及与住院时间相关的总费用更高。糖尿病组的住院死亡率、术后并发症发生率、住院时间、非常规出院率和总费用显著增加（P < 0.001）。具体地说，我们发现所有骨折严重程度的糖尿病患者（闭合性单踝、闭合性双踝或三踝以及脱位或开放性骨折）在医院多住了一天左右（平均4.7天，而3.6天），并增加了2000多美元的费用（平均值为12 898美元，而平均值为10 794美元）。这项在美国住院患者中进行的全国代表性研究提供了证据，表明踝关节骨折手术治疗的糖尿病患者在术后并发症方面可能比非糖尿病患者的结果更差，死亡率、非常规出院率、住院时间和总住院费用。
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 $10,794).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 charges.