title: Association of type 2 diabetes with prolonged hospital stay and increased rate of readmission in patients with lower limb cellulitis.
abstract: OBJECTIVE
  Lower limb (LL) cellulitis-related hospitalisations are prevalent in type 2 diabetes subjects. We assess its costs and factors associated with length of stay and readmissions.
  
  
  METHODS
  A retrospective case-control study at an urban hospital servicing a multi-ethnic population in New Zealand, where 7% of the adult population is estimated to have diabetes. Admissions with LL cellulitis in 2008-2013 were identified using coding records. Subsequent hospitalisations after 1 month with the same diagnosis were classified as readmissions. Glycaemic control was assessed by HbA1c measured within 6 months of the index admission.
  
  
  RESULTS
  There were 4600 admissions with LL cellulitis in 3636 patients, including 719 patients (20%) with type 2 diabetes. Hospital stay was longer for type 2 diabetes patients (median 5.3 vs 3.0 days, P < 0.001), independent of age, ethnicity and HbA1c. Accompanying LL ulceration was more frequent in type 2 diabetes patients (50% vs 17%, P < 0.001); however, admissions remained longer for type 2 diabetes patients without ulceration (median 3.4 vs 2.8 days, P < 0.001). Readmission rates were also higher in type 2 diabetes patients compared to non-diabetes patients (HR 1.7, P < 0.001), even in the absence of ulceration (HR 2.2, P < 0.001). Age, HbA1c and ethnicity did not distinguish those prone to readmissions in the type 2 diabetes cohort. Type 2 diabetes patients accounted for a fifth of all admissions and one third of the estimated costs.
  
  
  CONCLUSIONS
  A high proportion of patients with type 2 diabetes was admitted with LL cellulitis. They had significantly longer admissions and higher readmission rates. Age, HbA1c and ethnicity did not predict length of stay or recurrence.
authors.affiliation: Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland, New Zealand.
authors.forename: S M
authors.initials: SM
authors.lastname: Wijayaratna
authors.affiliation: Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: T
authors.initials: T
authors.lastname: Cundy
authors.affiliation: Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland, New Zealand.
authors.forename: P L
authors.initials: PL
authors.lastname: Drury
authors.affiliation: Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland, New Zealand.
authors.forename: S
authors.initials: S
authors.lastname: Sehgal
authors.affiliation: Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand.
authors.forename: S A
authors.initials: SA
authors.lastname: Wijayaratna
authors.affiliation: Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland, New Zealand.
authors.forename: F
authors.initials: F
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002481:Cellulitis / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: diabetes complications; hospitalisations; lower limb cellulitis; readmissions; type 2 diabetes