Effect of Malnutrition in Operatively Treated Ankle Fractures for Insulin- and Non-Insulin-Dependent Diabetic Patients

Category: Trauma; Ankle Introduction/Purpose: It has been widely demonstrated that patients with insulin-dependent diabetes mellitus (IDDM) have higher complication rates compared to non-insulin dependent diabetic patients (NIDDM) after operative treatment of ankle fractures. However, there is a paucity of research comparing the preoperative nutritional status of IDDM versus NDDM patients, as a modifiable preoperative risk factor. Therefore, this investigation examined whether diagnosis of IDDM, and preoperative serum albumin predicted various complications following operative fixation of ankle fractures. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried, and patients undergoing operative treatment of ankle fractures from 2007-2020 were identified for inclusion. Patients were stratified based on diabetic and insulin-dependent status. Outcomes measured were complications within the 30-day postoperative period, analyzed univariate and multivariate regressions. Results: IDDM patients had rates of malnutrition of 41.9% nearly twice the rates of NDDM patients (24.8%) or non-diabetic patients (17.3%). Patients who were malnourished were two times more likely to develop a complication (OR:2.01 [1.38, 2.91], p < 0.001). Malnourished patients had significantly increased incidence of bleeding requiring transfusions (0.5% versus 2.8%, p < 0.001), requiring postoperative ventilation (0.5% versus 0.1% p = 0.048), sepsis (0.4% versus 1.3% p=0.0046), UTI (0.9% versus 2.0% p=0.046). However, there was no increased incidence of deep vein thrombosis (0.7% versus 1.0% p=0.46), pneumonia (0.7% versus 1.0%, p=0.56), surgical site infections (0.1% versus 0.3%, p=0.30), wound dehiscence (0.4% versus 0.5%. p=0.76), pulmonary embolism (0.4% versus 0%, p=0.15) or myocardial infarction (0.1% versus 0.5%, p=0.15) in malnourished patients. Conclusion: Retrospective study of 884 patients who underwent ankle open reduction and internal fixation demonstrated that decreased preoperative albumin was associated with increased complications within the 30-day postoperative period.