Epidemiology of Infections, Readmissions, and Reoperations after 1434 Foot and Ankle Surgeries at an Academic Medical Center

Category: Other Introduction/Purpose: Foot and ankle orthopaedic procedures account for approximately 10% of all orthopaedic procedures annually, however, limited data exists on the rates of infection, readmissions and reoperations after surgery. Current literature in other fields of orthopaedic surgery suggests that patient characteristics, including body mass index (BMI), age, gender, race/ethnicity, smoking status, and comorbidities, may impact these rates. The variety of foot and ankle procedures performed presents a challenge when counseling patients on post-operative complications and mitigating risk. Methods: In this retrospective study of 1434 foot and ankle surgeries performed at a large, urban medical center by a single surgeon, patient demographics, pre-operative comorbidities, and post-operative complications within 90 days, including superficial wound infection, readmission, and reoperation, were analyzed using Chi-square test of independence. Preoperative demographics analyzed included age, diabetes mellitus (DM) status, smoking status, race/ethnicity, body mass index (BMI), and perioperative opioid use. Results: The overall rate of superficial wound infection was 2.3% (n=33); readmission and reoperation rates were 3.3% (n=47) and 3.6% (n=51), respectively. Patients who had DM, were 70 years or older, smoke tobacco products, had no perioperative opioid use, and had BMI >25 were all independently associated with higher rates of readmissions by 90 days (p < 0.05). Smoking tobacco products and perioperative opioid use were associated with higher rates of reoperation within 90 days (p < 0.001). Patients with perioperative opioid use also had higher rates of infection (p=0.0002). Age, DM, smoking status, race/ethnicity, BMI, and procedure type were not associated with differences in rate of infections. Conclusion: In elective and non-elective foot and ankle orthopaedic surgery, older age, DM, smoking and BMI>25 were associated with increased postoperative complications. The association of opioid use perioperatively and lower complication rates represents an area of future investigation. The conclusions of this study should be used to counsel patients on their anticipated risks of surgery and help identify areas risk mitigation to prevent and avoid complications.