Diabetes Mellitus and Outcomes After Operative Ankle Fracture Fixation in Older Adults: A Multicenter FOOTAGE Study
Benjamin Hershfeld, Allison J. Lewis, Lisa K. Cannada, Antonio Farinhas, Tristan P. Brunet, Hannah Peterson, Michael S. Linn, Ariel T. Goldman, Christopher M. McAndrew, Brian D. Rust, John D. Adams, Kyle Jeray, Kyle J. Adams, Emily B. Williams, Zachary Langston, Frederick K. Swiger, Ellen Lutnick, Alexandra Wadhwani, Eoin Devoy, Mark Anders, Dustin Morgan, Dustin A. Greenhill, Justin Zhu, Kevin G. Valdes, Brett D. Crist, Kyle M. Schweser, Nash Kolb, Trever T. Simon, Andrew Monhollen, Brianna Fram, Michelangelo Pagan, Lauren M. Tatman, William T. Obremskey, Juanita M. Velasco-Castro, Andres F. Moreno-Diaz, Jarrod E. Dumpe, William M. Malarkey, Adithi Shyam, Scott P. Ryan, Orett Burke, Monica Hennessey, Ari Khalameyzer, Mohammad K. Jamal, Christina Stylianou, Vir Kalaria, Adam D. BittermanBackground:
Diabetes mellitus is associated with adverse outcomes after ankle fracture surgery, but its relationship to medical complications, infection, and readmission in older adults remains incompletely defined. This study evaluated the association between diabetes and postoperative outcomes after operative ankle fracture fixation in older adults.
Methods:
A multicenter retrospective cohort study was performed using the Fracture Outcomes in Older Trauma–Ankle Geriatric Experience (FOOTAGE) consortium. Patients aged 60-100 years who underwent operative treatment of an isolated ankle fracture from 2014 to 2024 were included. Patients were grouped by diabetes status, defined as preexisting diabetes mellitus documented in the medical record. Diabetes type, insulin dependence, hemoglobin A 1c , other measures of glycemic control, diabetic neuropathy, and neuropathy severity were not available. Primary outcomes were any medical complication, deep infection, and 30-day readmission. Multivariable logistic regression adjusted for demographic, comorbidity, functional, and injury-related factors.
Results:
Among 1713 operatively managed patients, 500 had diabetes and 1213 did not. Patients with diabetes had higher unadjusted rates of any complication (31.8% vs 22.3%; relative risk [RR] 1.42, 95% CI 1.21-1.68;
Conclusion:
Diabetes was independently associated with medical complications, 30-day readmission, and deep infection after operative ankle fracture fixation in older adults. These findings support diabetes-specific counseling, optimization, wound surveillance, and readmission prevention.
Level of Evidence:
Level III, retrospective cohort study.