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

The purpose of this study was to compare the rates of readmission, reoperation, and mortality in patients with and without diabetes mellitus during the 30-day postoperative period after ankle fracture surgery. Patients who underwent operative management for ankle fractures between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program ^® database by using Current Procedural Terminology codes for ankle fracture surgery. A total of 17,464 patients undergoing ankle fracture surgery were identified. Of these patients, 2044 (11.7%)had diabetes and 15,420 (88.3%)did not have diabetes. We excluded patients older than 90 years or with inadequate perioperative data. Patients with diabetes had significantly higher rates of readmission (2.84% vs 1.05%, p <.0001), significantly higher rates of unplanned reoperation (2.3% vs 0.74%, p <.0001), and significantly higher rates of mortality (0.7% vs 0.2%, p <.0001)compared with patients without diabetes. Additionally, patients with diabetes had significantly greater age-adjusted odds ratios (ORs)of unplanned readmission (OR 2.40, 95% confidence interval [CI]1.74 to 3.31, p <.0001), unplanned reoperation (OR 2.56, 95% CI 1.44 to 3.27, p <.0001), and mortality (OR 2.01, 95% CI 1.08 to 3.62, p =.0432)than did patients without diabetes after ankle surgery. In this large-scale retrospective study, we demonstrated that the presence of diabetes significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality during the 30-day postoperative period after ankle fracture surgery.