The Journal of Bone and Joint Surgery (American). 2005;87:1712-1718.
doi:10.2106/JBJS.D.02625
© 2005 The Journal of Bone and Joint Surgery, Inc.
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The Impact of Diabetes on Patient Outcomes After Ankle Fracture

Shanti P. Ganesh, MPH1, Ricardo Pietrobon, MD, PhD2, William A.C. Cecílio, RN3, Deng Pan, MSc2, Nina Lightdale, MD2 and James A. Nunley, MD2

1 5111 Copper Ridge Drive, Apartment 108, Durham, NC 27707. E-mail address: ganes001{at}mc.duke.edu
2 Division of Orthopedic Surgery (R.P., N.L., and J.A.N.) and Center for Excellence in Surgical Outcomes (R.P. and D.P.), Duke University Medical Center, Durham, NC 27710
3 PUC Paraná-Brazil-Catholic University of Paraná, Immaculate Street, Conceição, 1155, The Old Prado, Curitiba, PR CEP, Brazil

Investigation performed at Duke University Medical Center, Durham, North Carolina

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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