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Neuropathy and Poorly Controlled Diabetes Increase the Rate of Surgical Site Infection After Foot and Ankle Surgery

Wukich, Dane K. MD1; Crim, Brandon E. DPM1; Frykberg, Robert G. DPM, MPH2; Rosario, Bedda L. PhD3

Journal of Bone & Joint Surgery - American Volume: 21 May 2014 - Volume 96 - Issue 10 - p 832–839
doi: 10.2106/JBJS.L.01302
Scientific Articles
Supplementary Content
Disclosures

Background: This prospective study was designed to evaluate the frequency of surgical site infection in patients treated with foot and ankle surgery. Our hypothesis was that patients with complications of diabetes are at increased risk for surgical site infection compared with patients without diabetes and patients with diabetes who do not have diabetic complications. Another goal was to compare the association of neuropathy with surgical site infection in both nondiabetic and diabetic patients.

Methods: Two thousand and sixty consecutive surgical cases were evaluated. Group 1 included nondiabetic patients without neuropathy, Group 2 included nondiabetic patients with neuropathy, Group 3 included patients with diabetes but no diabetic complications, and Group 4 included patients with diabetes who had at least one complication of diabetes.

Results: The surgical site infection rate in this study was 3.1%. Patients with complicated diabetes had a 7.25-fold increased risk of surgical site infection compared with nondiabetic patients without neuropathy and a 3.72-fold increased risk compared with patients with uncomplicated diabetes. Patients with complicated diabetes had a nonsignificant 1.54-fold higher rate of surgical site infection compared with nondiabetic patients with neuropathy. Nondiabetic patients with neuropathy had a significant 4.72-fold increased risk of surgical site infection compared with nondiabetic patients without neuropathy. Despite this, nondiabetic patients with neuropathy did not have a significantly higher rate of surgical site infection than patients with uncomplicated diabetes, and the frequency of surgical site infection in the group with uncomplicated diabetes was not significantly different from that in the nondiabetic patients without neuropathy. Multivariable logistic regression analysis demonstrated that peripheral neuropathy and a hemoglobin A1c of ≥8% were independently associated with surgical site infection.

Conclusions: Complicated diabetes increases the risk of surgical site infection after foot and ankle surgery. Patients who had diabetes without complications did not have a greater risk of surgical site infection compared with nondiabetic patients without neuropathy. The presence of neuropathy increases the risk of surgical site infection even in patients without diabetes. Poor long-term glycemic control is also associated with an increased risk of surgical site infection.

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

1Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 2100 Jane Street, Pittsburgh, PA 15203. E-mail address for D.K. Wukich: wukichdk@upmc.edu

2Phoenix VA Healthcare System, 650 East Indian School Road, Phoenix, AZ 85012

3Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, 127 Parran Hall, Pittsburgh, PA 15213

Investigation performed at the UPMC Mercy Center for Healing and Amputation Prevention, Pittsburgh, Pennsylvania

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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