SLR - August 2019 - Sangho Kim

Medical Comorbidities Increase the Rate of Surgical Site Infection in Primary Achilles Tendon Repair

Reference: Malcolm Dombrowski, Christopher D. Murawski, Youichi Yasui, Antonia F. Chen, Samuel O. Ewalefo. Medical Comorbidities Increase the Rate of Surgical Site Infection in Primary Achilles Tendon Repair Knee Surg Sports Traumatol Arthrosc. 2019 Jan 20. doi: 10.1007/s00167-018-5295-6.

Scientific Literature Review

Reviewed By: Sangho Kim, DPM
Residency Program: NYU Langone Hospital – Brooklyn, NY

Podiatric Relevance: The Achilles tendon is a common injury site in the human body. Achilles tendon ruptures often arise in  active middle age males, and has been  associated with fluroquinolone use, corticosteroid injections and renal transplants. The treatment for Achilles tendon ruptures is still debated between surgical and conservative management since the outcome is often comparable. This article gives an  idea which comorbidities result in higher chances of surgical site infections. The goals for this article is to assess the association of medical comorbidities on the incidence of surgical site infection following primary Achilles tendon repair. A secondary goal was to assess the effects of specific medical comorbidities on the cost and extent of healthcare utilization related to surgical site infections following primary Achilles tendon repair.

Methods: A total 24,269 patients who had primary Achilles tendon repair between 2005 and 2012 were studied. The data is from the United Healthcare Orthopedic and Medicare databases. The CPT code for primary Achilles tendon repair, and incision and drainage were used to identify subjects. The primary outcome regarding surgical site infection after primary Achilles tendon repair was the rate of infection occurrence, cost, and duration of treatment.

Results: Of the 24,269 patients included, 41.4 percent were female and 58.0 percent male, with 61.9 percent under the age of 65 years old. A total of thirty comorbidies were investigated. If a medical comorbidity was present at the time of surgery (18.0 percent vs. 6.0 percent without a comorbidity, p < 0.0001),) there was a significantly increased rate of postoperative surgical site infection (SSI). Diabetic patients with vascular complications had the highest SSI rate, followed by peripheral vascular disease, diabetics with peripheral neuropathy, history of drug abuse, fluid and electrolyte abnormalities, obesity, and uncomplicated diabetes. There was a significant increase in the average provider charge per claim and total number of health care encounters if a medical comorbidity was present at the time of Achilles tendon repair.

Conclusions: Patients undergoing Achilles tendon repair with medical comorbidities can increase the chance of surgical site infection, cost of care and duration of treatment. It is important to understand the relationship between each medical comorbidity and risk of surgical site infection for Achilles tendon repair to choose appropriate surgical candidates and to improve patient outcomes.

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