Diabetes Mellitus and Outcomes After Operative Ankle Fracture Fixation in Older Adults: A Multicenter FOOTAGE Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: 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; P < .001), any medical complication (19.0% vs 10.5%; RR 1.81, 95% CI 1.42-2.32; P < .001), 30-day readmission (6.8% vs 2.5%; RR 2.75, 95% CI 1.70-4.44; P < .001), and deep infection (6.4% vs 3.7%; RR 1.73, 95% CI 1.11-2.68; P = .015). After adjustment, diabetes remained associated with any medical complication (adjusted odds ratio [aOR] 1.61, 95% CI 1.18-2.21; P = .003), 30-day readmission (aOR 2.13, 95% CI 1.24-3.65; P = .006), and deep infection (aOR 1.66, 95% CI 1.01-2.74; P = .045), but not overall orthopaedic complications or revision surgery. 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.
Source: Foot & Ankle Orthopaedics
Authors: 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. Bitterman
Institutions: Northwell Health, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Huntington Hospital, University of North Carolina at Chapel Hill, Long Island Jewish Medical Center, Washington University in St. Louis, Prisma Health, University at Buffalo, State University of New York, St. Luke's Hospital, University of Missouri Health System, University of Chicago Medical Center, Vanderbilt University Medical Center, Navicent Health, Tufts Medical Center
Language: English
Topic: Foot and Ankle Surgery
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,200
OpenAlex ID: W7214970735