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

Liu, Jennifer W.; Ahn, Junho; Raspovic, Katherine M.; Liu, George T.; Nakonezny, Paul A.; Lavery, Lawrence A.; Wukich, Dane K.

doi:10.1053/j.jfas.2018.09.023

Cited by 33 publications

(20 citation statements)

References 31 publications

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“…Es gibt wenig Literatur, die sich mit der Sterbewahrscheinlichkeit von Patienten der septischen Unfallchirurgie befasst. Wir [11,12]. Insgesamt scheint jedoch nicht nur die Anzahl der Neben-erkrankungen, sondern auch die Schwere der jeweiligen Erkrankung entscheidend zu sein [34,35,36,37,38,39].…”

Section: Mortalität In Abhängigkeit Vonunclassified

Erhöhtes Alter, kardiovaskuläre Nebenerkrankungen, COPD und Diabetes mellitus bedingen eine Übersterblichkeit in der septischen Unfallchirurgie

et al. 2022

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Zusammenfassung Hintergrund Die konstante Überalterung der Bevölkerung in Deutschland führt u.a. zu einer Zunahme des durchschnittlichen Alters hospitalisierter Patienten. Hiermit einher gehen eine reduzierte physiologische Reserve und ein reduzierter körpereigener Abwehrmechanismus und folglich eine gesteigerte Infekt- und Komplikationsanfälligkeit. Die Altersentwicklung der septischen Unfallchirurgie ist im Vergleich zur Unfallchirurgie wenig erforscht. Zudem ist der Einfluss des Alters, verschiedener Vorerkrankungen, aber auch der des Alkohol- und Nikotinkonsums auf die Mortalität in der septischen Unfallchirurgie unzureichend untersucht. Methode 2014/15 (Exam1) wurden 345 Patienten der septischen Unfallchirurgie in die Studie eingeschlossen. 2017/18 (Exam2) erfolgte das 3-Jahres-Follow-up. Die Befragungen (Exam1 und 2) umfassten demografische Parameter, Nebenerkrankungen, die Medikamenteneinnahme, Alkohol- und Nikotinkonsum sowie verschiedene Parameter zur Morbidität. Hieraus wurde das Sterberisiko in der septischen Unfallchirurgie in Abhängigkeit von den verschiedenen Risikofaktoren (Alter, Nebenerkrankungen, Medikamenteneinnahme und Noxen) berechnet. Zudem wurde die Entwicklung des Patientenalters in der Unfallchirurgie sowie speziell in der septischen Unfallchirurgie zwischen 2010 und 2019 ausgewertet. Ergebnisse 2014/15 (Exam1) wurden 345 Patienten in die Studie eingeschlossen. Hiervon konnten 2017/18 274 (79,4%) telefonisch erreicht werden. 36 (10,4%) lehnten eine Nachbefragung ab. 20 (8,4%) der 238 verbleibenden Probanden waren bereits verstorben, 218 (63,2%) nahmen erneut teil. Zwischen 2010 (n = 492) und 2019 (n = 885) nahm die Patientenzahl der septischen Unfallchirurgie in unserer Abteilung um 79,9% zu, wobei besonders der Anteil der unter 65-Jährigen anstieg. Ab dem 60. Lebensjahr stieg die Sterbewahrscheinlichkeit (60. Lj: 0,0377 vs. 70. Lj: 0,1395) sprunghaft an; wobei in der septischen Unfallchirurgie die eines 60-Jährigen der Sterbewahrscheinlichkeit eines 80-Jährigen der Normalbevölkerung entsprach. Nikotin- (p = 0,93) und Alkoholkonsum (p = 0,344) zeigten keinen signifikanten Einfluss auf die Sterblichkeit, während kardiale Vorerkrankungen (p = 0,01), die COPD (p = 0,01), der Diabetes mellitus (p = 0,05) und die pAVK (p = 0,01) mit einer signifikant erhöhten Sterblichkeit einhergingen. Schlussfolgerung Das Alter, kardiale Vorerkrankungen, aber auch die COPD, der Diabetes mellitus und die periphere arterielle Verschlusskrankheit gehen mit einer signifikant erhöhten Sterblichkeit in der septischen Unfallchirurgie einher. Eine exponentielle Zunahme des Sterblichkeitsrisikos besteht zwischen dem 50. und 60. Lebensjahr, wobei das Risiko zu versterben eines 60-jährigen Patienten der septischen Unfallchirurgie dem eines 80-jährigen aus der Normalbevölkerung entspricht.

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Section: Mortalität In Abhängigkeit Vonunclassified

Erhöhtes Alter, kardiovaskuläre Nebenerkrankungen, COPD und Diabetes mellitus bedingen eine Übersterblichkeit in der septischen Unfallchirurgie

et al. 2022

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“…Ankle fractures represent 9% of all fractures and are widely known to have an increased risk of complications in diabetic patients. 9 , 12 , 13 , 19 , 20 , 25 , 26 , 28 , 32 , 34 , 46 , 47 An estimated 34.5 million people (10.5%) in the United States are diabetic, a number that is expected to rise to 44.1 million over the next decade. 8 , 27 Common sequalae of poorly controlled diabetes, most notably peripheral neuropathy, lead to increased risk of surgical site infection (SSI), malunion, nonunion, in-hospital mortality, and amputation.…”

Section: Introductionmentioning

confidence: 99%

“…8 , 27 Common sequalae of poorly controlled diabetes, most notably peripheral neuropathy, lead to increased risk of surgical site infection (SSI), malunion, nonunion, in-hospital mortality, and amputation. 19 , 20 , 26 , 28 , 32 , 34 , 46 , 47 Given the tandem rise of ankle fractures 4 , 6 , 14 , 29 and diabetes mellitus in the United States, we seek to identify factors that may increase complications in diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

“…Although the presence of symmetric, distal peripheral neuropathy and diabetic nephropathy have been used as independent variables in studies of diabetic ankle fracture cohorts, these factors were generally treated as dichotomous in their analysis. 26 , 32 , 38 , 46 Despite this, the disease severity and diabetic sequelae likely affect complication rates after surgery. Wukich et al’s 46 single-center retrospective cohort study on postoperative complications in diabetic ankle fractures stratified patients based on the presence of complicated diabetes, defined as diabetes-associated peripheral neuropathy, nephropathy, or peripheral arterial disease.…”

Section: Introductionmentioning

confidence: 99%

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Diabetic Kidney Disease Is Associated With Increased Complications Following Operative Management of Ankle Fractures

Polachek

Baker

Dahm

et al. 2022

Foot & Ankle Orthopaedics

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Background: Diabetes mellitus and peripheral neuropathy are established risk factors for complications in operatively treated ankle fractures. Generally, the presence of peripheral neuropathy and diabetic nephropathy have been used as independent variables in studies of diabetic ankle fracture cohorts but are typically treated as binary risk factors. Our purpose was to quantify the effects of risk factors on complication rate specific to diabetic patients undergoing ankle fracture fixation. Methods: We identified 617 rotational ankle fractures treated operatively at a single academic medical center from 2010 to 2019, of which 160 were identified as diabetic. Of these, 91 ankle fractures in 90 diabetic patients met criteria for retrospective review of clinical and radiographic data. Criteria included perioperative laboratory studies, including glycated hemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR), as well as follow-up radiographs in the electronic record. We defined complications in this surgical cohort as deep surgical site infection, unplanned return to the operating room, and failure of fixation. Logistic regression was performed and odds ratios (ORs) calculated. Results: The overall complication rate was 28.6% (26/91) in this cohort. Median follow-up was 29 weeks (range: 5-520 weeks). Mean perioperative HbA1c in patients who experienced postoperative complications was 7.6% (range: 5.1%-14.2%) compared with 7.8% (range: 5.6%-13.5%) who did not ( P = .69). Diabetic patients with chronic kidney disease (eGFR <60 mL/min per body surface area) (OR 5.29, P = .006) and peripheral neuropathy (OR 4.61, P = .003) were at significantly higher risk of all complications compared with diabetic patients without these comorbidities. Of note, we did not find an association between perioperative HbA1c or body mass index and complication rate. Conclusion: Patients with diabetes complicated by chronic kidney disease are at significantly higher risk of complications following operative management of ankle fractures. Our study also corroborated previous reports that within this high-risk cohort, the presence of peripheral neuropathy is a significant risk factor for complications. These sequalae of diabetic disease are manifestations of microvascular disease, glycosylation of soft tissues, and impaired metabolic pathways. Identifying these risk factors in diabetic patients allows for patient-specific risk stratification, education, and management decisions of ankle fractures. Level of Evidence: Level III, retrospective cohort study.

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“…It could achieve anatomic reduction, stable immobilization, and early movement of ankle joints. However, severe complications have been reported, including wound infection and even postoperative amputation and mortality in patients with diabetes mellitus [ 8 , 9 ]. This modality is also contraindicated when soft tissue is poor in many elderly patients [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Effects and Anti-rotation Stabilization of the Non-bridging External Fixation for Pronation-Abduction Stage III Ankle Fracture: A Cadaveric Study

Chen

Huang

Cheng

et al. 2021

BioMed Research International

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Objective. This study is aimed at providing a nonbridging external fixation technique with pinning fixation for the pronation-abduction stage III ankle fracture. The secondary purpose was to evaluate its effect on anatomic reduction and fracture fragment stability against cadaveric models’ rotation. Method. A paired design study was conducted using 14 pairs of the cadaveric model which had been modeled for pronation-abduction stage III ankle fracture. One fracture model from each pair was randomly allocated to receive an open reduction and internal fixation, while the other was reduced and stabilized with the external fixation technique. After the surgery, the antirotational stability tests were performed with external rotation torques of 10 nm, 15 nm, and 20 nm applied, respectively. The postoperation reduction rate and ankle parameters were recorded in anteroposterior and lateral radiographs before and after the antirotational stability experiment. Result. The outcomes were assessed according to Burwell-Charnley’s radiographic criteria of reduction. It showed no statistically significant differences in reduction between the two groups ( P < 0.05 ). The displacement of lateral fragment following a reduction in the external fixation group was significantly larger than that of the internal fixation group ( 3.14 ± 0.56 vs. 1.49 ± 0.39 , P < 0.05 ). After applying rotational torques of 10 nm, 15 nm, and 20 nm, the results of other parameters showed no significant differences between the two groups. Conclusion. This nonbridging external fixation method with pin fixation of fracture fragments might have the same effect as that of internal fixation on the reduction rate of pronation-abduction stage III ankle fracture.

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

Cited by 33 publications

References 31 publications

Erhöhtes Alter, kardiovaskuläre Nebenerkrankungen, COPD und Diabetes mellitus bedingen eine Übersterblichkeit in der septischen Unfallchirurgie

Erhöhtes Alter, kardiovaskuläre Nebenerkrankungen, COPD und Diabetes mellitus bedingen eine Übersterblichkeit in der septischen Unfallchirurgie

Diabetic Kidney Disease Is Associated With Increased Complications Following Operative Management of Ankle Fractures

Effects and Anti-rotation Stabilization of the Non-bridging External Fixation for Pronation-Abduction Stage III Ankle Fracture: A Cadaveric Study

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