Therapeutics and Clinical Risk Management (Aug 2022)
Intertrochanteric Fracture Surgery Patients with Diabetes Mellitus are Prone to Suffer Perioperative Neurological and Endocrine/Metabolic Complications: A Propensity-Score Matched Analysis
Abstract
You Tang,1,* Le Kang,2,* Meng Guo,3 Linlin Fan4 1Department of Joint Surgery, Binzhou People’s Hospital, Binzhou, People’s Republic of China; 2Department of Hand Surgery & Microsurgery and Foot & Ankle Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People’s Republic of China; 3Department of Rehabilitation, Binzhou Medical University Hospital, Binzhou, People’s Republic of China; 4Department of Child Healthcare, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People’s Republic of China*These authors contributed equally to this workCorrespondence: You Tang, Department of Joint Surgery, Binzhou People’s Hospital, Binzhou, People’s Republic of China, Email [email protected]: In older adults, the recovery after hip fracture surgery is not always to be well expected due to high risks of adverse outcomes including perioperative complications and mortality. We aimed to evaluate the intertrochanteric fracture (IF) patients with diabetes mellitus (DM) and receiving surgical fixation with intramedullary nail on the perioperative complications, total hospital costs (THC), length of hospital stay (LOS), and mortality.Methods: In this retrospective cohort study, among 487 consecutive intertrochanteric fracture patients with age over 65 years and treated surgically by using intramedullary nail between Jan. 2015 and Mar. 2020, 353 patients were included, including 81 with DM and 272 without DM. After using propensity-score matched (PSM) analysis, 80 patients remained in each group. The perioperative complications, 30-day, 90-day, 1-year, and 2-year survival rates, THC, and LOS were observed and compared between two groups. Overall survival was compared by Kaplan–Meier method.Results: No significant between-group differences were found in 30-day, 90-day, 1-year, and 2-year mortality rates, THC, LOS, and other perioperative complications after PSM and McNemar’s tests (all p> 0.05), except for neurological complications (p< 0.004) and endocrine/metabolic complications (p< 0.001). At a mean follow-up time of 36.2 months, there were no statistically significant differences between the groups based on the Kaplan–Meier survival curve (p=0.171, log-rank).Conclusion: IF surgery patients with DM are more prone to suffer perioperative neurological and endocrine/metabolic complications and they should be managed individually while being aware of these risks henceforth. Further high evidence clinical trials are needed to expand in DM patients with IF.Keywords: hip fracture, older adults, perioperative complications, mortality, propensity-score matched
