Ankle and Hindfoot Fusions: Comparison of Outcomes in Patients with and without Diabetes

Abstract

This study confirmed our hypothesis that patients with DM were at increased risk for postoperative complications after foot and/or ankle arthrodesis when compared to patients without DM. A secondary finding of this study demonstrated patients with poor short- and long-term glucose control experienced more complications.

Diabetes and its negative impact on outcomes in orthopaedic surgery

“…Diabetic patients experienced higher rates of infectious and noninfectious complications. Complication rates were also higher in patients with suboptimal short and long term glycemic control [32] . Ankle fractures in patients with DM are also associated with higher complication rates when compared to patients without DM [33,34] .…”

“…Peripheral neuropathy and a hemoglobin A1c of ≥ 8% were independently associated with SSI [31] . Arthrodesis surgery is commonly performed for foot and ankle problems in patients with DM, and complications of surgery are higher in diabetic patients [32] . A retrospective review compared 74 diabetic patients and 74 non-diabetic patients.…”

What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

“…Costigan et al [17] reported infection in 83% of patients with diabetes lacking preoperative pedal pulses and 92% with peripheral neuropathy after surgical treatment for ankle fractures. Numerous studies have supported associations with increased wound complications and surgical site infections in patients with complicated diabetes, peripheral vascular disease, and wound compromising medications [8,16,23,36,43,44,59]. Other comorbidities associated with increased risk of postoperative infection include obesity, malnutrition, tobacco use, and immunosuppressive medication [11,21,43,45].…”

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

“…Diabetic patients who undergo foot and ankle surgery are particularly vulnerable to both infectious and noninfectious complications due to the comorbidities of peripheral neuropathy, Charcot neuroarthropathy, peripheral artery disease, and foot ulcers 8,9 . Increased infection rates have been observed in diabetic patients following ankle fracture repair or major foot and ankle arthrodesis 8,10,11 .…”

“…Increased infection rates have been observed in diabetic patients following ankle fracture repair or major foot and ankle arthrodesis 8,10,11 . A retrospective controlled study demonstrated that patients with complications of diabetes had higher rates of surgical site infection after foot and ankle surgery when compared with patients with uncomplicated diabetes and patients without diabetes 6 .…”