TY - JOUR
T1 - Postoperative outcomes in diabetic pediatric orthopaedic surgery patients
T2 - A national database study
AU - Farahani, Farzam
AU - Ahn, Junho
AU - Nakonezny, Paul A.
AU - Wukich, Dane K.
AU - Wimberly, Robert L.
AU - Riccio, Anthony I.
N1 - Funding Information:
The authors thank the American College of Surgeons for utilization of their database for this study.
Publisher Copyright:
© 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - Background: Although the negative effects of diabetes mellitus (DM) on operative outcomes in orthopaedic surgery is a well-studied topic in adults, little is known about the impact of this disease in children undergoing orthopaedic procedures. This study aims to describe the postoperative complications in pediatric orthopaedic surgery patients with DM. Methods: Pediatric patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) were retrospectively identified while selecting for elective orthopaedic surgery cases from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-Pediatric) database from 2012 to 2015. Univariate and multivariate analyses were performed to describe and assess outcomes when compared with nondiabetic patients undergoing similar procedures. Results: Of the 17,647 patients identified, 105 (0.60%) had DM. Of those 105 patients, 68 had IDDM and 37 had NIDDM. The median age of DM patients was 13.8 years (11.9 to 15.5 y) and 37.1% of all DM patients were male. Comparing DM to non-DM patients, no significant differences were noted in the overall complications (1.4% vs. 1.9%, P > 0.05) or reoperation rates (1.2% vs. 1.9%, P > 0.05); however, DM patients did have a higher occurrence of unplanned readmissions (4.8% vs. 1.7%; P = 0.037). Diabetic patients were statistically more likely to have an unplanned readmission with 30 days (adjusted odds ratio = 3.34; 95% confidence interval = 1.21-9.24, P = 0.021). when comparing IDDM to NIDDM, there was no significant difference in outcomes. Comparing NIDDM to non-DM patients, there was an increased incidence of nerve injury (5.6% vs. 0.18%; P = 0.023), readmission rate (11.1% vs. 1.8%; P = 0.043), and reoperation rate (11.1% vs. 1%; P = 0.013) in nonspinal procedures and an increased incidence of pulmonary embolism (10% vs. 0%; P = 0.002) in spinal arthrodesis procedures. NIDDM predicted longer hospital stays (adjusted odds ratio = 1.49; 95% confidence interval = 1.04, 2.14; P = 0.028) compared with nondiabetic patients in extremity deformity procedures. Conclusions: The 30-day complication, reoperation, and readmission rates for NIDDM patients were higher than that of non-DM patients. Furthermore, NIDDM is a predictor of longer hospital stays while DM is a predictor of unplanned readmissions. No statistical differences were noted when comparing outcomes of NIDDM to IDDM patients. Level of Evidence: Level III.
AB - Background: Although the negative effects of diabetes mellitus (DM) on operative outcomes in orthopaedic surgery is a well-studied topic in adults, little is known about the impact of this disease in children undergoing orthopaedic procedures. This study aims to describe the postoperative complications in pediatric orthopaedic surgery patients with DM. Methods: Pediatric patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) were retrospectively identified while selecting for elective orthopaedic surgery cases from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-Pediatric) database from 2012 to 2015. Univariate and multivariate analyses were performed to describe and assess outcomes when compared with nondiabetic patients undergoing similar procedures. Results: Of the 17,647 patients identified, 105 (0.60%) had DM. Of those 105 patients, 68 had IDDM and 37 had NIDDM. The median age of DM patients was 13.8 years (11.9 to 15.5 y) and 37.1% of all DM patients were male. Comparing DM to non-DM patients, no significant differences were noted in the overall complications (1.4% vs. 1.9%, P > 0.05) or reoperation rates (1.2% vs. 1.9%, P > 0.05); however, DM patients did have a higher occurrence of unplanned readmissions (4.8% vs. 1.7%; P = 0.037). Diabetic patients were statistically more likely to have an unplanned readmission with 30 days (adjusted odds ratio = 3.34; 95% confidence interval = 1.21-9.24, P = 0.021). when comparing IDDM to NIDDM, there was no significant difference in outcomes. Comparing NIDDM to non-DM patients, there was an increased incidence of nerve injury (5.6% vs. 0.18%; P = 0.023), readmission rate (11.1% vs. 1.8%; P = 0.043), and reoperation rate (11.1% vs. 1%; P = 0.013) in nonspinal procedures and an increased incidence of pulmonary embolism (10% vs. 0%; P = 0.002) in spinal arthrodesis procedures. NIDDM predicted longer hospital stays (adjusted odds ratio = 1.49; 95% confidence interval = 1.04, 2.14; P = 0.028) compared with nondiabetic patients in extremity deformity procedures. Conclusions: The 30-day complication, reoperation, and readmission rates for NIDDM patients were higher than that of non-DM patients. Furthermore, NIDDM is a predictor of longer hospital stays while DM is a predictor of unplanned readmissions. No statistical differences were noted when comparing outcomes of NIDDM to IDDM patients. Level of Evidence: Level III.
KW - Diabetes
KW - Orthopaedic surgery
KW - Outcomes
KW - Pediatric
UR - http://www.scopus.com/inward/record.url?scp=85113100007&partnerID=8YFLogxK
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U2 - 10.1097/BPO.0000000000001879
DO - 10.1097/BPO.0000000000001879
M3 - Article
C2 - 34138820
AN - SCOPUS:85113100007
SN - 0271-6798
VL - 41
SP - E664-E670
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
IS - 8
ER -