SLR - June 2012 - Casey Friske
Reference: Wukich DK, McMillen RL, Lowery NJ, Frykberg, RG. (2011 Aug 4). Surgical Site Infections After Foot and Ankle Surgery, A Comparison of Patients With and Without Diabetes. Diabetes Care.
Scientific Literature Review
Reviewed by: Casey Friske, DPM
Residency Program: OCPM & University Hospital Richmond Heights Medical Center
Podiatric Relevance:
Podiatric surgery always carries an inherent risk of soft tissue/surgical site infections. A prospective study of 1,465 patients demonstrated a significant increase in surgical site infections in diabetics. This research study shows the risk of morbidity and mortality in the diabetic population which should be considered prior to any surgical intervention.
Methods:
All surgeries were performed by a single surgeon. Each patient was evaluated for neuropathy as well as peripheral arterial disease. Each patient was covered by one dose of preoperative antibiotics and 24 hours of coverage perioperatively. Exclusion criterion was a positive deep soft tissue or bone culture. A surgical site infection was defined as occurring within 30 days postoperatively.
Results:
Of 1,465 surgical patients, three were excluded due to not reaching the minimum 30 day follow up period. Overall, 51 of the remaining 1,462 (3.5 percent) were diagnosed with a surgical site infection. There were 221 patients that were diabetic, and 21 (9.5 percent) were diagnosed with a surgical site infection. The remaining 1,241 non-diabetic patients experienced 30 (2.4 percent) infections. On univariate analysis of other associations that demonstrated significance include: increased age, male, having Charcot neuroarthropathy, previous or current ulcer, increased length of surgery, peripheral neuropathy and tobacco. Non-significant associations explored include: American Society of Anesthesiology (ASA) classification, serum creatinine, obesity, PAD, rheumatoid arthritis and a history of organ transplant.
Conclusions:
Chronic complications of diabetes such as peripheral neuropathy increase the risk of surgical site infections by nearly a factor of four. The ability of the physician to recognize and diagnose neuropathy is imperative given nearly 50 percent of diabetics with neuropathy are asymptomatic. The ability to identify these patients will aid in decreasing the risk of postoperative infection.