Objective: In this study, we assess the differences in
peri-operative mortality and morbidity between diabetic and non-diabetic
patients following hip surgery.
Methods: This is a prospective study of 119 patients admitted with hip fracture during a 14 month period. Patients were divided into two groups, diabetics (n=19) and non-diabetics (n=100). Information was collected including patient demographics, functional status, medical co-morbidities (using the CCI – Charlson Co-morbidity Index tool), previous history of fractures, vitamin D level and supplementation, fracture type and duration to surgery. Immediate post-operative complications, rate of 30-day mortality and length of rehabilitation stay were analysed and compared between the two groups. The validity of the results was assessed using the Chi-square statistic for categorical variables and the t-test for continuous variables using the Systat program.
Results: The mean age was significantly different for each group with diabetics presenting 6 years earlier (age 77.5 versus 83.5, p = 0.03).The CCI score had a bimodal distribution in diabetics. Other baseline characteristics were comparable between the two groups. Diabetic patients post hip fracture surgery were observed to have higher percentage of cardiac complications (53.3 % versus 27.6%, p=0.049), including serious complications such as acute coronary syndromes and heart failure (46.7% versus 10.5%, p=0.0005). Diabetic patients were also more likely to develop multiple (≥ 3) complications than non-diabetic patients post hip surgery (53.3% versus 26.3%, p=0.037), notably anaemia requiring blood products, cardiac, pulmonary and renal complications. 30-day mortality outcomes and length of stay were not statistically significant between the two groups.
Conclusion: Diabetic patients have an increased risk of having multiple complications post hip surgery and importantly serious cardiac complications. The medical care in the peri-operative period should be maximised in diabetic patients to prevent complications.