The burden of inpatient care for diabetic and non-diabetic patients with osteoporotic hip fractures—does it differ? An analysis of patients recruited into a fracture liaison service in Southeast Asia
- 243 Downloads
Hospital care and mortality of diabetic and non-diabetic osteoporotic Asian patients undergoing hip fracture surgery were explored with no difference in length of hospitalization, incidence of post-operative complications, or mortality between diabetics and non-diabetics seen. Time to operation correlated with post-operative complications occurrence and therefore surgery should be expeditiously done.
Whether burden of inpatient care, problems after admission, and mortality rates differ between diabetics and non-diabetics undergoing surgery for osteoporotic hip fractures has not been explored in Asian populations.
Three hundred eighty-nine multi-ethnic diabetic and non-diabetic patients recruited into a FLS at a large Asian hospital with new osteoporotic hip fractures requiring operative repair were analyzed.
87.9% were Chinese, 6.4% Malay, and 3.6% Indians. BMI and age did not significantly differ between diabetics and non-diabetics. Median (IQR) length of hospitalization (LOHS) in days was 12 (9, 17) in diabetics and 11 (8, 14) in non-diabetics (p = 0.011). Median time from admission to operation (TTO) was 3 (2, 5) in diabetics versus 2 (1, 4.5) in the non-diabetics (p = 0.003). Occurrence of aggregate post-operative complications did not differ between diabetics and non-diabetics. No in-hospital mortalities occurred in either group. Thirty-day and 1-year mortality rates did not differ between the two groups. One-year mortality was 2.8% in the entire cohort. On multivariate regression analysis adjusted for age and race, only TTO (β; 1.8, 95% CI 1.5–2.0, p < 0.001) and occurrence of post-operative complications (β; 6.3, 95% CI 3.7–7.9, p < 0.001) correlated with LOHS. TTO and age-adjusted Charlson’s Comorbidity Index (CCI) correlated significantly with the development of post-operative complications.
Diabetes was not independently associated with LOHS in patients undergoing hip fracture surgery. Aggregate post-operative complications did not differ between diabetics and non-diabetics. TTO and occurrence of post-operative complications significantly affected LOHS. TTO correlated with post-complications development. Surgery should be expeditiously done in both diabetics and non-diabetics to avoid the development of post-operative complications and to prevent prolonged hospital stay.
KeywordsDiabetes Length of hospital stay Time to operation Mortality Hip fractures Fracture liaison service
Compliance with ethical standards
Conflict of interest
- 2.Lee CMY, Huxley RR, Lam TH, Martiniuk ALC, Ueshema H, Pan WH, Welborn T, Woodward M, Asia Pacific Cohort Studies Collaboration (2007) Prevalence of diabetes mellitus and population attributable fractions for coronary heart disease and stroke mortality in the WHO South-East Asia and Western Pacific regions. Asia Pac J Clin Nutr 16(1):187–192PubMedGoogle Scholar
- 18.Lopez-de-Andrés A, Jiménez-García R, Jiménez-Trujillo I, Hernández-Barrera V, de Miguel-Yanes JM, Méndez-Bailón M, Perez-Farinos N, de Miguel-Diez J, Salinero-Fort MÁ, Carrasco-Garrido P (2016) Incidence, surgical procedures, and outcomes of hip fracture among elderly type 2 diabetic and non-diabetic patients in Spain (2004-2013). Osteoporos Int 27(2):605–616CrossRefGoogle Scholar
- 29.Maheshwari K, Planchard J, You J, Sakr WA, George J, Higuera-Rueda C, et al. Early surgery confers one-year mortality benefit in hip-fracture patients. J Orthop Trauma. 2017.Google Scholar