LAUSR

OBJECTIVES (1) To determine the incidence of surgical site infections (SSIs) in diabetic orthopaedic trauma patients and (2) to establish a protocol for managing diabetes mellitus (DM) in orthopaedic trauma patients. DESIGN Retrospective cohort study. SETTING Level 1 Trauma Center. PATIENTS All diabetic orthopaedic trauma patients who underwent surgical intervention with at least one month follow-up. Patients were classified as poorly-controlled or controlled diabetic patients based on admission hemoglobin A1c and blood glucose (BG). INTERVENTIONS Orthopaedic surgical intervention in accordance with fracture type and a standardized diabetes management protocol with internal medicine co-management. MAIN OUTCOME MEASUREMENT SSI incidence. RESULTS There were 260 patients during the study period. Two hundred two (77.7%) were included in the final analysis. Seventy-five (37.1%) patients met the criteria for poorly-controlled DM. The overall rate of SSI was 20.8%; 32.0% for poorly-controlled diabetic patients and 14.2% for controlled diabetic patients (p<0.01). Admission blood glucose (BG, p=0.05), but not discharge BG, was associated with SSI incidence. CONCLUSIONS Trauma patients with poorly-controlled DM have a higher rate of SSIs than patients with controlled DM. Perioperative diabetes control does not appear to decrease infection rates in these patients. LEVEL OF EVIDENCE Therapeutic, Level III.