Effect of Elevated Blood Glucose on Postoperative Complications Among Diabetic Patients After Surgical Treatment of Torsional Ankle Fracture.

Abstract

This study aims to evaluate the association of elevated blood glucose and postoperative complications among diabetic patients after surgical treatment of torsional ankle fracture. This was a retrospective study of consecutive diabetic patients treated surgically for a torsional ankle injury between January 2017 and December 2021 at a large tertiary hospital. All patients who met inclusion and exclusion criteria were divided into a high-HbA_1c group or a low-HbA_1c group according to the HbA_1c cutoff of 7.0% within 3 months of operation, then a propensity score match was performed to control potential confounding factors. The primary outcomes were postoperative complications, and secondary outcomes were unplanned secondary procedures. A matched cohort of 238 patients was finally included, with 119 patients with high HbA_1c levels and 119 with low HbA_1c levels. Patients with high HbA_1c levels experienced more complications (31.1% vs 18.5%, <i>P</i> < .01) and more secondary procedures (22.7% and 8.4%, <i>P</i> < .01) than those with low HbA_1c levels. Multivariate logistic regression indicated that patients with high HbA_1c levels were significantly associated with higher proportions of any complications (OR 2.25, 95% CI 1.08-4.69; <i>P</i> = .03), superficial infection (OR 4.03, 95% CI 2.13-5.41; <i>P</i> < .01), deep infection (OR 1.42, 95% CI 1.23-2.02; <i>P</i> < .01), and any unplanned secondary operations (OR 3.72, 95% CI 1.62-8.52; <i>P</i> < .01) compared with those with low HbA_1c levels after controlling for potential confounders. Multivariate linear regression showed that high HbA_1c levels were significantly associated with a higher number of complications (β = 4.61, 95% CI 2.63-18.18; <i>P</i> < .01) and a higher number of secondary procedures (β = 4.44, 95% CI 2.79-10.87; <i>P</i> < .01). Patients with an HbA_1c >7.0% within 3 months of operation are more likely to have a wound issue/infection and more likely to undergo a secondary procedure after surgical treatment of torsional ankle fractures in diabetic patients than patients with an HbA_1c ≤7.0% within 3 months of operation.