SLR - December 2023 - Peter
Title: Risk Factors for Surgical Site Infections in Elective Orthopedic Foot and Ankle Surgery. The Role of Diabetes MellitusReference: Soldevila-Boixader L, Viehöfer A, Wirth S, Waibel F, Yildiz I, Stock M, Jans P, Uçkay I. Risk Factors for Surgical Site Infections in Elective Orthopedic Foot and Ankle Surgery: The Role of Diabetes Mellitus. Journal of Clinical Medicine. 2023; 12(4):1608. https://doi.org/10.3390/jcm12041608.
Level of Evidence: Level III
Reviewed By: Matthew Peter, DPM
Residency Program: Cambridge Health Alliance – Cambridge, MA
Podiatric Relevance: In the context of elective orthopedic foot and ankle surgery, this article has podiatric relevance with a focus on surgical site infections in the setting of diabetes mellitus. Surgical site infections can lead to significant morbidity and healthcare costs in the diabetic patient population. The clinical question addressed is the identification of risk factors, particularly the influence of diabetes, which can help refine preventative strategies and improve patient outcomes.
Methods: A retrospective analysis of elective foot and ankle surgeries was performed of cases from January 2014 to September 2022 at an orthopedic referral center in Zurich, Switzerland. The data was sourced from hospital databases, excluding emergency surgeries and those conducted for infections or severe ischemia. Diabetic and non-diabetic groups were established. The study investigated various variables, including surgery duration, type of surgery, number of prior surgeries, surgery involving foreign material, ASA score, and the presence of chronic wounds in diabetic patients. These variables were used to assess the risk of surgical site infections.
Results: Of the 6138 elective surgeries included in the study, the findings revealed a surgical site infection risk of 1.88%. Risk factors for surgical site infections were identified, including higher ASA scores (3-4), the presence of internal or external material, and a history of more than two previous surgeries. Most notably, the study highlighted diabetes mellitus as a significant risk factor for surgical site infections, especially when combined with pre-existing diabetic foot ulcers. The study also touched upon the microbiological findings in surgical site infections, indicating that Staphylococcus species were the most predominant pathogens, with some strains resistant to treatment. These findings emphasized the importance of optimized perioperative antibiotic prophylactic measures, particularly for high-risk patients, to reduce surgical site infections rates.
Conclusions: From the results of this study, the authors concluded that several factors contribute to the risk of surgical site infections in elective orthopedic foot and ankle surgery. Notably, diabetes mellitus, especially when combined with a diabetic foot ulcer, was noted to be a significant risk factor. These findings emphasize the importance of meticulous patient risk assessment and optimized perioperative antibiotic prophylaxis to minimize surgical site infections. In clinical practice, this information underscores the necessity for tailored care for diabetic patients, with a focus on glycemic control, wound management, and infections prevention strategies. The study additionally prompts further research to refine preventative measures and improve surgical outcomes in this patient population.