High-risk profile for perioperative diabetic ketoacidosis in patients undergoing femoral fracture surgery and prevention implications
4 affiliations
- 1Key Laboratory of Orthopedic Biomaterials Research and Clinical Transformation, Guangxi Health Commission, The Fourth Affiliated Hospital of Guangxi Medical University/Liu Zhou Worker's Hospital
- 2Department of Orthopedic, Nanfang Hospital, Southern Medical University
- 3The Fourth Clinical College, Henan Medical University
- 4Department of Pediatrics, Weill Cornell Medicine
Abstract
Background/Objective: Diabetic ketoacidosis (DKA) is a severe metabolic complication, but data on perioperative DKA in patients undergoing femoral fracture surgery remain limited. This study aimed to identify risk factors and associated complications of perioperative DKA in this population using the National Inpatient Sample (NIS).
Methods: This retrospective study analyzed NIS data from 2016–2022. Patients with traumatic femoral fracture who underwent internal fixation were identified by ICD-10-CM/PCS codes. DKA was identified by ICD-10 codes E08.1, E09.1, E10.1, E11.1, and E13.1. Multivariable models examined demographic, hospital, comorbidity, and complication associations, with FDR correction.
Results: Among 337,988 patients, 579 had perioperative DKA. Annual DKA proportions ranged from 0.128% to 0.219%, with an overall increasing trend (Cochran-Armitage p=0.00272). In the comorbidity-domain model, additional diabetes coding (OR=4.074, 95% CI 3.209–5.173) and fluid/electrolyte disorders (OR=3.695, 95% CI 2.982–4.580) were strongly associated with DKA and remained significant after FDR correction. DKA was also associated with sepsis, acute renal failure, shock, pressure ulcer, dialysis, intestinal obstruction, and acute myocardial infarction, as well as longer length of stay and higher hospitalization costs.
Conclusions: Perioperative DKA after femoral fracture surgery is uncommon but showed an increasing trend and was strongly associated with diabetes, fluid/electrolyte disorders, severe complications, and greater healthcare utilization. These findings support targeted metabolic monitoring in high-risk patients.
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BibTeX
@article{chen2026highrisk,
title = {{High-risk profile for perioperative diabetic ketoacidosis in patients undergoing femoral fracture surgery and prevention implications}},
author = {Kaiwei Chen and Boqi Geng and Hongxi Mo and Zuhao Wu and Xiongjie Liang and Xiaozhong Peng and Jiwei Luo and Xingzhan Feng and Jun Xiao and Qinfeng Yang and Tao Li and Jianlong Li},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.1976707},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1976707/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - High-risk profile for perioperative diabetic ketoacidosis in patients undergoing femoral fracture surgery and prevention implications
AU - Kaiwei Chen
AU - Boqi Geng
AU - Hongxi Mo
AU - Zuhao Wu
AU - Xiongjie Liang
AU - Xiaozhong Peng
AU - Jiwei Luo
AU - Xingzhan Feng
AU - Jun Xiao
AU - Qinfeng Yang
AU - Tao Li
AU - Jianlong Li
PY - 2026
DA - 2026/11/02
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1976707
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1976707/full
AB - Background/Objective: Diabetic ketoacidosis (DKA) is a severe metabolic complication, but data on perioperative DKA in patients undergoing femoral fracture surgery remain limited. This study aimed to identify risk factors and associated complications of perioperative DKA in this population using the National Inpatient Sample (NIS). Methods: This retrospective study analyzed NIS data from 2016–2022. Patients with traumatic femoral fracture who underwent internal fixation were identified by ICD-10-CM/PCS codes. DKA was identified by ICD-10 codes E08.1, E09.1, E10.1, E11.1, and E13.1. Multivariable models examined demographic, hospital, comorbidity, and complication associations, with FDR correction. Results: Among 337,988 patients, 579 had perioperative DKA. Annual DKA proportions ranged from 0.128% to 0.219%, with an overall increasing trend (Cochran-Armitage p=0.00272). In the comorbidity-domain model, additional diabetes coding (OR=4.074, 95% CI 3.209–5.173) and fluid/electrolyte disorders (OR=3.695, 95% CI 2.982–4.580) were strongly associated with DKA and remained significant after FDR correction. DKA was also associated with sepsis, acute renal failure, shock, pressure ulcer, dialysis, intestinal obstruction, and acute myocardial infarction, as well as longer length of stay and higher hospitalization costs. Conclusions: Perioperative DKA after femoral fracture surgery is uncommon but showed an increasing trend and was strongly associated with diabetes, fluid/electrolyte disorders, severe complications, and greater healthcare utilization. These findings support targeted metabolic monitoring in high-risk patients.
SN - 1664-2392
ER -