title: Effect of diabetes mellitus on perioperative complications and hospital outcomes after ankle arthrodesis and total ankle arthroplasty.
abstract: BACKGROUND
  The aim of this investigation was to analyze a nationally representative admissions database to evaluate the effect of diabetes mellitus on the rate of perioperative complications and hospitalization outcomes after ankle arthrodesis (AAD) and total ankle arthroplasty (TAA).
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, 12 122 patients who underwent AAD and 2973 patients who underwent TAA were identified from 2002 to 2011 based on ICD-9 procedure codes. The perioperative complications and hospitalization outcomes were compared between diabetic and nondiabetic patients for each surgery during the index hospital stay.
  
  
  RESULTS
  The overall complication rate in the AAD group was 16.4% in diabetic patients and 7.0% in nondiabetic patients (P < .001). Multivariate analysis demonstrated that diabetes mellitus was independently associated with an increased risk of myocardial infarction (relative risk [RR] = 3.2, P = .008), urinary tract infection (RR = 4.6, P < .001), blood transfusion (RR = 3.0, P < .001), irrigation and debridement (RR = 1.9, P = .001), and overall complication rate (RR = 2.7, P < .001). Diabetes was also independently associated with a statistically significant increase in length of hospital stay (difference = 0.35 days, P < .001), more frequent nonhome discharge (RR = 1.69, P < .001), and higher hospitalization charges (difference = $1908, P = .04). The overall complication rate in the TAA group was 7.8% in diabetic patients and 4.7% in nondiabetic patients. Multivariate analysis demonstrated that diabetes was independently associated with increased risk of blood transfusion (RR = 9.8, P = .03) and overall complication rate (RR = 4.1, P = .02). Diabetes was also independently associated with a statistically significant increase in length of stay (difference = 0.41 days, P < .001) and more frequent nonhome discharge (RR = 1.88, P < .001), but there was no significant difference in hospitalization charges (P = .64).
  
  
  CONCLUSIONS
  After both AAD and TAA, diabetes mellitus was independently associated with a significantly increased risk of perioperative complications, nonhome discharge, and length of hospital stay during the index hospitalization.
authors.affiliation: University of Chicago Medical Center, Chicago, IL, USA o.schipper@gmail.com.
authors.forename: Oliver N
authors.initials: ON
authors.lastname: Schipper
authors.affiliation: University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Jimmy J
authors.initials: JJ
authors.lastname: Jiang
authors.affiliation: NorthShore University Health System, Evanston, IL, USA.
authors.forename: Lan
authors.initials: L
authors.lastname: Chen
authors.affiliation: NorthShore University Health System, Evanston, IL, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Koh
authors.affiliation: University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Toolan
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D058737:Arthroplasty, Replacement, Ankle; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: ankle arthritis; ankle arthrodesis; ankle arthroplasty; diabetes mellitus; hospitalization outcomes; perioperative complications