Evaluating Factors Associated with Increased Risk of Perioperative Complications in Foot and Ankle Surgery

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Foot and ankle surgery encompasses a wide range of procedures aimed at restoring function, alleviating pain, and improving the quality of life for patients with musculoskeletal disorders. Advances in surgical techniques and implant technology have led to improved clinical outcomes across various procedures, from ligament reconstructions to joint-preserving and joint-replacing surgeries. However, understanding complication profiles and surgical risk factors remains essential for optimizing patient outcomes. Previous studies evaluating postoperative complications in foot and ankle surgery have been limited by small sample sizes and single-institution experiences, highlighting the need for large-scale, contemporary data. Establishing benchmarks for surgical safety and efficacy enables evidence-based decision-making, enhances preoperative planning, and improves patient counseling. Methods: A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent foot and ankle surgery between 2011 and 2023 was performed. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. That said, logistic regression of risk factors, such as BMI class, age, sex, diabetic status, dialysis status, smoking status, history of COPD, history of steroid medication, and bleeding disorders, were evaluated in minor and major complications. Odds ratio and significance values were reported. Results: A total of 136,958 patients were included in this analysis. The table below summarizes our findings comprehensively. The overall complication rate was found to be 6.7%; the minor complications rate was found to be 5.5%; and the major complications was found to be 2% in the perioperative and short-term setting. Notably, underweight patients had more minor complications (p-value <.001), but no significant difference in major complications. In contrast, overweight and class I morbid obesity patients lowered odds of minor and major complications rates significantly (p-values < 0.001). In addition, class II morbid obesity was found to have decreased minor complications. Furthermore, diabetes, dialysis, smoking, COPD, steroid usage, and bleeding disorders all had significantly higher rates of both minor and major complications (p-values < 0.001). Conclusion: In this study, the rate of minor and major complications was found to align with previously understood rates in the perioperative setting. BMI’s impact on complications varies based on class, and as such, physicians should be mindful of how their weight potentially impacts their risk profile. Also, diabetes, dialysis, smoking, COPD, steroid use, and bleeding disorders were all significant risk factors for increased complication rates. Overall, this study provides critical insights into perioperative risk stratification, emphasizing the importance of patient optimization before undergoing foot and ankle surgery.