Association of Diabetes Mellitus and Immediate Postoperative Complications after Total Ankle Replacement: A Large Database Analysis

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total Ankle Replacement (TAR) has rapidly grown in popularity over the last fifteen years as a treatment for ankle arthritis. With this growth, it is imperative to understand risk factors that may predispose patients to complications following the procedure. This information can be valuable in generating treatment plans and facilitating conversation regarding risks and benefits of those plans. Current literature on TAR-related outcomes is limited in timeframe and scope and does not investigate the association of diabetes with common post operative complications. The objective of this study was to perform a retrospective database analysis to quantify the risk of 90-day complications in patients with diabetes undergoing TAR when compared to patients without diabetes undergoing TAR. Methods: The TriNetX database was utilized for this study. Patients who underwent TAR were identified and stratified by those with a history of diabetes mellitus and those without a history of diabetes mellitus of any type. The cohorts were 1:1 propensity matched based on demographic information and medical history. The 90-day complication rates for readmission, inpatient service use, opioid use, anesthesia use, periprosthetic fracture, deep vein thrombosis, and wound dehiscence were calculated using chi-square analysis. Results: n=5,984 TAR patients were identified. 52% were male and 48% female with mean age of 73±10 years. There was a n=1,331 patients in each the patients with diabetes and without diabetes groups after cohort analysis and propensity matching. TAR patients with diabetes had a significantly higher 90-day odds ratio of inpatient service use (OR: 1.675, 95% CI 1.3082-2.144; p< 0.001). There was no significant difference between groups in opioid use (OR: 1.13, 95% CI 0.941-1.357; p=0.1908), anesthesia use (OR: 1.335, 95% CI 0.906-1.965; p=0.1424), and wound dehiscence (OR: 1.313, 95% CI 0.829-2.08; p=0.2445); Table 1. There was insufficient data to determine the role of diabetes on critical care services, periprosthetic fracture, and DVT within 90 days of TAR. Conclusion: TAR is a developing operation for ankle arthritis and little data exists on diabetes related perioperative complications. The results of this study show that although diabetes is significantly associated with a higher rate of inpatient service use, it may not have as large a role in opioid use, anesthesia use, and wound dehiscence in the immediate postoperative period. More information is still needed to address long term outcomes and the role diabetes plays in other postoperative complications.