The Prevalence of Diabetes Mellitus and Its Impact on Orthopaedic Inpatient Outcomes — ASN Events
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The Prevalence of Diabetes Mellitus and Its Impact on Orthopaedic Inpatient Outcomes (#322)

Alvin Kong 1 2 , Natalie Nanayakkara 1 , Wei-Ling Chiu 1 , Erosha Premaratne 1 , Leonid Churilov 3 , Frida Djukiadmodjo 4 , Elizabeth Owen-Jones 5 , Graeme K Hart 6 , Nicholas Crinis 7 , Raymond Robbins 8 , Doug Johnson 9 , Scott T Baker 1 9 , Elif I. Ekinci 1 2 10 , Jeffrey D Zajac 1 2
  1. Department of Endocrinology, Austin Health, Heidelberg West, Victoria, Australia
  2. University of Melbourne, Parkville, Victoria, Australia
  3. The Florey Institute of Neuroscience & Mental Health, Melbourne, Victoria, Australia
  4. Austin Health, Heidelberg, Victoria, Australia
  5. Austin Centre for Applied Clinical Informatics, Austin Health, Heidelberg, Victoria, Australia
  6. Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
  7. Pathology Department, Austin Hospital, Heidelberg, Victoria, Australia
  8. Department of Administrative Informatics, Austin Hospital, Heidelberg, Victoria, Australia
  9. Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia
  10. Menzies School of Health Research, Darwin, Northern Territory, Australia

Introduction: Diabetes prevalence is rising1 and given higher rates of musculoskeletal-related comorbidities in patients with diabetes2, this represents a progressive burden on the orthopaedic inpatient setting. HbA1c testing is a superior option for diabetes diagnosis in the acute hospital inpatient setting3.  Few studies have examined the prevalence of diabetes and influence of HbA1c on orthopaedic inpatient outcomes.

Objectives: To investigate the prevalence of diabetes mellitus and its impact on hospital outcomes and post-operative complication rates in orthopaedic inpatients.

Methods: All patients aged ≥54 years admitted to Austin Health between July 2013 and January 2014 had routine automated HbA1c measurements coordinated by the Diabetes Discovery Initiative and the Cerner Millennium® Health IT system. Patients with HbA1c ≥6.5% were diagnosed with diabetes. Baseline demographic and clinical data were obtained from the hospital medical records.

Results: Of the 416 orthopaedic inpatients included in this study, 22% (n=93) had diagnosed diabetes, 4% (n=15) had previously unrecognized diabetes and 74% (n=308) did not have diabetes. Patients with diabetes (diagnosed and unrecognized) had significantly higher Charlson comorbidity scores compared to patients without diabetes (median, IQR; 1 [0,2] vs 0 [0,0], p<0.001). After adjusting for age, gender, comorbidity score and estimated-glomerular-filtration-rate (Table1), no significant differences in the length of stay (IRR=0.92; 95%CI: 0.79-1.07; p=0.280) and rates of intensive care unit admission (OR=1.04; 95%CI: 0.42-2.60, p=0.934), inpatient mortality (OR=0.52; 95%CI: 0.17-1.60, p=0.252), 6 months hospital readmission (OR=0.93; 95%CI: 0.46-1.87; p=0.828) or any post-operative complications (OR=0.98; 95%CI: 0.53-1.80; p=0.944) were observed between the two groups. In particular, no significant differences in the rates of post-operative infections (OR=0.84; 95%CI: 0.34-2.10; p=0.711), acute renal failure (OR=2.06; 95%CI: 0.58-7.32; p=0.266), delirium (OR=1.34; 95%CI: 0.45-3.99; p=0.602) or anaemia (OR=1.36; 95%CI: 0.70-2.61; p=0.364) were detected between patients with and without diabetes.

Conclusions: More than one in four patients admitted to a tertiary hospital orthopaedic ward are affected by diabetes mellitus. No statistically significant differences in the rates of post-operative outcomes and complications were identified between patients with and without diabetes. Future studies with larger cohorts and longer follow-up time may provide further insight into the impact of diabetes on orthopaedic inpatient outcomes.

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  1. Magliano DJ, Peeters A, Vos T, Sicree R, Shaw J, Sindall C, et al. Projecting the burden of diabetes in Australia--what is the size of the matter? Aust N Z J Public Health. 2009;33(6):540-3.
  2. Kurup H, Thomas M. Orthopaedics and diabetes. Acta Orthop Belg. 2013;79(5):483-7.
  3. d'Emden MC, Shaw JE, Colman PG, Colagiuri S, Twigg SM, Jones GR, et al. The role of HbA1c in the diagnosis of diabetes mellitus in Australia. Med J Aust. 2012;197(4):220-1.