Impact of Diabetes Mellitus on Surgical Quality Measures After Ankle Fracture Surgery: Implications for "Value-Based" Compensation and "Pay for Performance"

Abstract

Objectives: To evaluate the impact of diabetes mellitus (DM) and associated complications on cost, length of stay, and inpatient mortality after open reduction internal fixation (ORIF) of an ankle fracture, and the implications of these variables during a time of health care payment reform.

Design: Retrospective study.

Setting: The Statewide Planning and Research Cooperative System database, which includes all admissions to New York State hospitals from 2000 to 2011.

Patients/participants: A total of 58,748 patients were identified as having undergone the primary procedure of ORIF of the ankle (ICD-9-CM procedure code 79.36).

Intervention: ORIF of the ankle.

Main outcome measure: Cost, length of stay, and inpatient mortality.

Results: Of the 58,748 patients evaluated, 7501 (12.8%) had DM. Mean length of stay and total hospital charges were significantly greater for the DM cohort compared to the without DM cohort (P < 0.01). Patients with DM had greater Charlson Comorbidity Index scores and greater in-hospital mortality than patients without DM (both P < 0.01). Of the patients with diabetes, 1098/7501 had complicated diabetes mellitus (C-DM). Patients with C-DM stayed 2.4 days longer and were $6895 more costly than those with diabetes alone (both P < 0.01). Patients with C-DM also had a significantly higher in-hospital mortality rate than those with diabetes alone.

Conclusions: Patients with diabetes admitted to the hospital for ankle ORIF have more expensive hospital stays and higher in-hospital mortality rates than patients without diabetes. The presence of diabetic complications further increases these risks. These data will help provide risk-adjustment for future health care payment reform initiatives.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.