Insulin Dependence as an Independent Predictor of Complications Following Surgical Treatment of Distal Radius Fracture

Purpose: Diabetes mellitus (DM) is a well-established risk factor for postoperative complications. Distal radius fractures (DRFs) are a common orthopedic injury and often require open reduction and internal fixation (ORIF). The rise of ORIF utilization warrants investigation into factors that may expose patients to postoperative complications following DRF ORIF. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for cases of DRF ORIF between 2015 and 2021. Cases were stratified into cohorts based on diabetes mellitus (DM) status. The DM cohort was further stratified into non-insulin-dependent DM (NIDDM) and insulin-dependent DM (IDDM) groups. Bivariate logistic regression was conducted to compare patient demographics, comorbidities, and 30-day postoperative complications. Multivariate logistic regressions were conducted to identify associations between diabetes mellitus status and postoperative complications. Results: A total of 27,761 cases of DRF ORIF were identified from 2015 to 2021. After exclusion criteria were applied, 25,971 cases remained, of which 2,169 (8.4%) cases had DM and 23,802 (91.6%) cases were free of DM. Within the DM cohort, there were 1,392 cases in the NIDDM subgroup and 777 cases in the IDDM subgroup. Relative to the nondiabetic cohort, the IDDM cohort was independently associated with sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off mechanical ventilation, readmission, and nonhome discharge. Conclusion: The IDDM cohort was independently associated with higher rates of postoperative sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off ventilation, readmission, and nonhome discharge when compared to the nondiabetic cohort following DRF ORIF. Level of Evidence: Level III; Retrospective Cohort Comparison; Prognosis Study