Association of Type 2 Diabetes with Prolonged Hospital Stay and Increased Rate of Readmission in Patients with Lower Limb Cellulitis.
Intern Med J. 2016 Oct 17;:
Authors: Wijayaratna SM, Cundy T, Drury PL, Sehgal S, Wijayaratna SA, Wu F
BACKGROUND/AIMS: Lower limb (LL) cellulitis related hospitalisations are prevalent in type 2 diabetes (T2DM) subjects. We assess its costs and factors associated with length of stay and readmissions.
METHODS: A retrospective case-control study at an urban hospital servicing a multi-ethnic population in New Zealand, where 7% of the adult population is estimated to have diabetes. Admissions with LL cellulitis in 2008-2013 were identified using coding records. Subsequent hospitalisations after 1 month with the same diagnosis were classified as readmissions. Glycaemic control was assessed by HbA1c measured within 6 months of the index admission.
RESULTS: There were 4600 admissions with LL cellulitis in 3636 patients, including 719 patients (20%) with T2DM. Hospital stay was longer for T2DM patients (median 5.3 vs. 3.0 days, p < 0.001), independent of age, ethnicity, and HbA1c. Accompanying LL ulceration was more frequent in T2DM patients (50% vs. 17%, p < 0.001); however admissions remained longer for T2DM patients without ulceration (median 3.4 vs. 2.8 days, p < 0.001). Readmission rates were also higher in T2DM patients compared to non-diabetes patients (HR 1.7, p < 0.001), even in the absence of ulceration (HR 2.2, p < 0.001). Age, HbA1c, and ethnicity did not distinguish those prone to readmissions in the T2DM cohort. T2DM patients accounted for a fifth of all admissions and one third of the estimated costs.
CONCLUSIONS: A high proportion of patients with type 2 diabetes were admitted with LL cellulitis. They had significantly longer admissions and higher readmission rates. Age, HbA1c, and ethnicity did not predict length of stay nor recurrence.
PMID: 27749001 [PubMed - as supplied by publisher]