Postoperative Outcomes in Diabetic Pediatric Orthopaedic Surgery Patients: A National Database Study
Farzam Farahani1, Junho Ahn1, Paul A Nakonezny2
1Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center.
Insights
Pediatric diabetes mellitus (DM) patients undergoing orthopaedic surgery had higher unplanned readmission rates. Non-insulin-dependent diabetes mellitus (NIDDM) predicted longer hospital stays and increased complications, while DM predicted unplanned readmissions.
Area of Science:
- Pediatric Orthopaedic Surgery
- Endocrinology
- Health Services Research
Background:
- Diabetes Mellitus (DM) negatively impacts adult surgical outcomes, but its effect on pediatric orthopaedic surgery is less understood.
- This study investigates postoperative complications in children with DM undergoing orthopaedic procedures.
Purpose of the Study:
- To describe and analyze postoperative complications in pediatric orthopaedic surgery patients with diabetes mellitus.
- To compare outcomes between diabetic (IDDM and NIDDM) and non-diabetic pediatric patients.
Main Methods:
- Retrospective analysis of pediatric patients with Insulin-Dependent Diabetes Mellitus (IDDM) and Non-Insulin-Dependent Diabetes Mellitus (NIDDM) from the ACS-NSQIP-Pediatric database (2012-2015).
- Inclusion of elective orthopaedic surgery cases.
- Univariate and multivariate analyses to compare outcomes between diabetic and non-diabetic groups.
Main Results:
- Diabetic patients (0.60%) showed no significant difference in overall complications or reoperation rates compared to non-diabetic patients.
- Diabetic patients had a higher incidence of unplanned readmissions (4.8% vs. 1.7%, P=0.037), with DM being a predictor of 30-day unplanned readmissions (AOR=3.34).
- Non-insulin-dependent diabetes mellitus (NIDDM) was associated with increased nerve injury, readmissions, and reoperations in non-spinal procedures, and pulmonary embolism in spinal arthrodesis. NIDDM predicted longer hospital stays in extremity deformity procedures.
Conclusions:
- Non-insulin-dependent diabetes mellitus (NIDDM) is linked to higher 30-day complication, reoperation, and readmission rates compared to non-diabetic patients.
- Diabetes mellitus (DM) predicts unplanned readmissions, while NIDDM predicts longer hospital stays.
- No significant outcome differences were observed between insulin-dependent diabetes mellitus (IDDM) and NIDDM patients.
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.
