Preoperative Risk Factors for Complications in Elective Ankle and Hindfoot Reconstruction

Mulligan, Ryan P.; McCarthy, Kevin; Grear, Benjamin J.; Richardson, David R.; Ishikawa, Susan N.; Murphy, G. Andrew

doi:10.1177/1938640017706155

Cited by 29 publications

(25 citation statements)

References 60 publications

(79 reference statements)

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“…By far, however, epidemiologic data on SSI following elective foot and ankle surgeries remain scarce. As far as we know, only very few studies focused on this subject and identified some risk factors, including alcohol use [ 10 ], preoperative narcotic use [ 10 ], advanced age [ 11 ], prolonged tourniquet time [ 11 ], tobacco use [ 11 ], complicated diabetes [ 4 ], perioperative antibiotics, and surgeon experience [ 12 ]. However, most of these risk factors were in controversy or inconclusive, which might be compromised by the small sample size or only inclusion of a specific population (diabetes mellitus, elderly, or foot and ankle trauma).…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Meng

Zhu

et al. 2020

J Orthop Surg Res

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Background This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors. Methods This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI. Results A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12). Conclusions SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.

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Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Meng

Zhu

et al. 2020

J Orthop Surg Res

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“…Additionally, the habit of smoking has been shown to increase the likelihood of surgical problems, as well as many postoperative complications, such as a higher incidence of infection and wound dehiscence after plastic surgery procedures 7 . Chronic exposure to cigarette smoke has been reported to have adverse effects on bone fracture repair and ligament healing that include heightened pain, longer hospitalization periods, and increased rate of hospital readmission 8 – 10 . Furthermore, smoking is considered a risk factor for non-healing and major amputation diagnosis in patients undergoing diabetic foot ulcer surgical treatment 11 , while a negative impact in number, size and overall healing of pressure injuries have also been reported 12 .…”

Section: Introductionmentioning

confidence: 99%

A Novel In Vivo Model to Study Impaired Tissue Regeneration Mediated by Cigarette Smoke

Alvarez

Chávez

Miranda

et al. 2018

Sci Rep

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Cigarette smoke is associated with several pathologies including chronic respiratory diseases and cancer. In addition, exposure to cigarette smoke is correlated with impaired wound healing, where a significant decrease in the regenerative capacity of smokers is well documented and broadly considered a negative risk factor after trauma or surgery. So far, some in vitro and in vivo models have been described to study how exposure to cigarette smoke diminishes the regenerative potential in different organisms. However, although useful, many of these models are difficult and expensive to implement and do not allow high-throughput screening approaches. In order to establish a reliable and accessible model, we have evaluated the effects of cigarette smoke extract (CSE) on zebrafish development and regeneration. In this work, zebrafish embryos and larvae were exposed to low doses of aqueous CSE showing severe developmental abnormalities in a dose-dependent manner. Furthermore, when adult zebrafish were subjected to caudal fin amputation, we observed a significant decrease in the regenerative capacity of animals exposed to CSE. The effect was exacerbated in male and aged fish compared to female or young organisms. The establishment of a zebrafish model to assess the consequences of cigarette smoke and its effects on animal physiology could provide a new tool to study the underlying mechanisms involved in impaired tissue regeneration, and aid the development of novel approaches to treat complications associated with cigarette smoke toxicity.

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“…The effect of length of surgery and patient smoking on wound healing was previously evaluated in the literature. 6 , 7 , 10 , 23 , 24 , 27 , 29 Wiewiorski et al 30 evaluated 290 elective foot and ankle procedures and found an increase in postoperative wound-healing complications with higher tourniquet times (odds ratio = 7.02) and smoking (odds ratio = 48.77). Using a registry of 56,216 total knee arthroplasties, Namba et al 24 found a nearly 9% increased risk of infection per 15-minute increase in surgical time.…”

Section: Discussionmentioning

confidence: 99%

Infection and Rerupture After Surgical Repair of Achilles Tendons

Jildeh

Okoroha

Marshall

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Surgical repair of an Achilles tendon rupture has been shown to decrease rerupture rates. However, surgery also increases the risk of complications, including infection.Purpose:To determine the risk factors for infection and rerupture after primary repair of Achilles tendon ruptures.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was performed on 423 patients who underwent operative treatment of Achilles tendon ruptures between the years 2008 and 2014. The primary outcome of interest was the total rate of infection, and the secondary outcome of interest was the incidence of rerupture within 2 years of operation.Results:A total of 423 patients were analyzed, with a mean age of 46 years (range, 16-83 years) and a mean body mass index of 31.4 kg/m2 (range, 17-55 kg/m2). The overall infection rate was 2.8%, and the rerupture rate was 1%. The median time between surgery and superficial surgical site infection was 30 days, and the median time between surgery and rerupture was 38 days. Longer tourniquet times (100.3 ± 34.7 minutes vs 69.9 ± 21.4 minutes; P = .04) and greater estimated blood loss (15.0 ± 9.1 mL vs 5.1 ± 12.0 mL; P = .01) were associated with an increased rate of deep surgical site infections. Patients who had longer operation and tourniquet times trended toward higher rerupture rates (P = .06 and .08, respectively). When compared with nonsmokers, current and previous smokers had an increased incidence of superficial or deep surgical site infections (6.25% vs 1.42%; P = .02). Age, sex, race, body mass index, alcohol use, diabetes, past steroid injections, and mechanism of injury did not contribute to complication rates.Conclusion:Achilles tendon repairs were associated with a low risk of infection and rerupture. Patients with longer tourniquet times, higher estimated blood loss, and a history of smoking were at increased risk for surgical site infections. Patients with longer operative times had increased rates of rerupture.

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Preoperative Risk Factors for Complications in Elective Ankle and Hindfoot Reconstruction

Abstract: Level III: Retrospective comparative study.

Cited by 29 publications

References 60 publications

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

A Novel In Vivo Model to Study Impaired Tissue Regeneration Mediated by Cigarette Smoke

Infection and Rerupture After Surgical Repair of Achilles Tendons

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