Insulin Dependent Diabetic Patients at Increased Risk of Complications after Upper Extremity Surgery
Jeffrey Stepan, MD, MSc; Venkat Boddapati, BA; Hayley A Sacks, BA; Michael C Fu, MD, MHS, Daniel A Osei, MD, MSc; Duretti T Fufa, MD
Hospital for Special Surgery, New York, NY
Introduction Diabetes Mellitus (DM) has been associated with development of carpal tunnel syndrome, Dupuytren's disease, trigger digits, and limited joint mobility. Despite descriptions of poorer response to conservative treatment, surgical outcomes in this population are not clearly understood. Previous studies have not shown increased complication rates in diabetic patients after hand surgery. Few studies, however, differentiate between insulin-dependent (IDDM) and non-insulin dependent diabetes (NIDDM). The purpose of this study is to evaluate the impact of insulin dependence on the postoperative risk profile of diabetic patients after hand surgery using a national database.
Materials and Methods The data was obtained through the National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing surgery from the distal humerus to the hand were identified using 297 distinct Current Procedural Terminology (CPT) codes between 2005 and 2015. Patient demographics, anesthesia type, procedure site, and thirty-day postoperative complications were collected (Table1). Outcomes were categorized into medical complications, surgical site complications, and return to the operating room. Complications were compared between patients with NIDDM or IDDM to those without DM using multivariate logistic regression, adjusting for baseline patient and operative characteristics.
Results Patients with DM were more likely to be older, female, and have a higher comorbidity burden and more proximal procedures performed than those without diabetes (Table 1). Patients with IDDM had a 5.7% overall complication rate compared to 2.3% and 1.5% in NIDDM and non-diabetics, respectively. After controlling for differences in patient and surgical characteristics, patients with IDDM had a statistically significant increased rate of any complication (OR 1.82, 95% CI = 1.44-2.3), surgical site complications (OR 2.35, 95% CI = 1.71-3.24), and superficial surgical site infections (OR 2.57, 95% CI 1.75-3.76). There was no significant difference in complication rates between patients with NIDDM and non-diabetics (Table 2).
Conclusion Our data demonstrates greater risk of complications following distal upper extremity surgeries for patients with IDDM, specifically surgical site infections. NIDDM patients did not have an increased rate of complications relative to non-diabetics. These findings are important in patient risk stratification and guiding further investigation to decrease complication rates in IDDM patients after upper extremity surgery.
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