SLR - December 2012 - Steffen Jr.

Review of a Retrospective Study on the Postoperative Infection Rate of Diabetics vs. Non-Diabetics

Reference: Dane K. Wukich, Nicholas J. Lowery, Ryan L. McMillen, Robert G. Frykberg; Postoperative infection rates in foot and ankle surgery: A comparison of patients with and without diabetes mellitus. The Journal of Bone & Joint Surgery. 2010 Feb;92(2):287-295.

Scientific Literature Review

Reviewed by: Kevin D. Steffen Jr., DPM
Residency Program: University Hospitals Richmond Medical Center

Podiatric Relevance:
In an ideal world, every patient would be a perfect candidate for surgery. In reality, not all patients are as healthy as we would like in podiatric practice. Diabetes, both complicated and non-complicated, is fairly common to a practicing podiatrist. Often times these diabetic patients require or elect to have surgery. It has always been stressed that diabetic patients have an increased rate of infection. This article is a great way to compare the postoperative infection rates among the different groups of patients.

Methods: 
In this study, 1,000 patients that underwent orthopaedic foot or ankle surgery had their charts reviewed. From this chart review, multiple demographic variables were pulled from the charts, including sex, age, history of diabetes, development of postoperative infection, severity of infection, inpatient or outpatient surgery, use of tobacco, history of organ transplant, history of rheumatoid arthritis, length of surgery, internal or external fixation, follow-up time, and comorbid conditions.

Results: 
This study demonstrated an overall infection rate among all patients to be 4.8 percent. Patients with diabetes had an infection rate of 13.2 percent, while the non-diabetic infection rate was 2.8 percent. Forty percent of the infections occurred in patients with external fixation devices. When the external fixation cases were removed, complicated diabetic patient infection rate was 17 percent and non-complicated diabetic patients the infection rate was 4 percent. Non-diabetic patients had an infection rate of 1.8 percent. 

Conclusions: 
It was determined overall that patients with diabetes have an increased rate of postoperative infection, up to five times the rate of non-diabetics. Furthermore, complicated diabetes increased the infection rate of up to 10 times that of non-diabetics. What was interesting was that non-diabetics and uncomplicated diabetics did not have a statistical difference in postoerativep infection rates. Even though this was a retrospective study on patients that were all managed by a single physician which may have created bias, there is a significant amount of data that sheds light on the increased risk of infection in the diabetic population when it comes to foot and ankle surgery.

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