The Impact of Metabolic Syndrome on 30-day Outcomes Following ORIF for Ankle Fractures

• Published in: Foot & ankle orthopaedics Vol. 4; no. 4
• Main Authors: Xie, Jack, Malik, Azeem Tariq, Quatman, Carmen E, Ly, Thuan V., Phieffer, Laura, Khan, Safdar N
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-10-2019; Sage Publications Ltd; SAGE Publishing
• Subjects: Ankle; Metabolic syndrome; metabolic syndrome; NSQIP; complications; ORIF; ankle fractures
• ISSN: 2473-0114; 2473-0114
• DOI: 10.1177/2473011419S00444

Category:
Ankle, Trauma
Introduction/Purpose:
Metabolic syndrome (MetS) has been shown to be associated with significant post-operative morbidity. Despite an increasing prevalence of MetS in the US population, it’s impact on post-operative outcomes following ankle fractures remains limited.
Methods:
The 2012-2016 ACS-NSQIP database was used to query for patients undergoing ORIF for ankle fractures using Current Procedural Terminology (CPT) codes – 27766, 27769, 27792, 27814, 27822 and 27823. Patient undergoing surgery for polytrauma were excluded from the analysis. Records were further filtered to remove patients with missing data. The study cohort was divided into two groups – MetS vs. No MetS. MetS was identified using a pre-defined criteria, used previously in other studies, as the co-existence of 1) Diabetes Mellitus, 2) Hypertension and 3) BMI =30 kg/m2.
Results:
A total of 1,013 (6.7%) MetS underwent ORIF for ankle fractures. Following adjustment for differences in baseline demographic, co-morbidities, pre-operative and operative data, MetS was an independent predictor of experiencing any 30-day complication (OR 1.35 [95% CI 1.05 -1.74]; p=0.020), wound complications (OR 1.67 [95% CI 1.07-2.60]; p=0.024), renal complications (OR 3.54 [95% CI 1.20-10.48]; p=0.022), 30-day readmissions (OR 1.66 [95% CI 1.24-2.22]; p=0.001), 30-day unplanned re-operations (OR 1.69 [95% CI 1.14-2.51]; p=0.009). MetS was significantly associated with decreased odds of home discharge (OR 0.66 [95% CI 0.54-0.79]; p<0.001).
Conclusion:
Patients with MetS undergoing ORIF for ankle fractures are at an increased risk of experiencing adverse complications, re-admissions and re-operations within 30-days of the surgery. Providers should understand the need of appropriate post-operative surveillance in this high-risk group to minimize the risk of poor outcomes.