Incidence and Predictors of Infection After Ankle Arthroscopy: A Multivariate Analysis from an 8-Year Cohort

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Ankle arthroscopy is a widely performed procedure for diagnosing and treating ankle pathologies. While generally safe, surgical site infections (SSIs) remain a concern, with reported incidences ranging from 0.13% to 3.08%. Although relatively uncommon, SSIs can delay rehabilitation, increase healthcare costs, and lead to severe complications like septic arthritis. Identifying predictors of infection is crucial to improving surgical outcomes. Previous studies suggest that diabetes mellitus (DM) and high body mass index (BMI) may be associated with increased infection risk, but data remain limited. This 8-year retrospective study aimed to determine the incidence of postoperative infections in ankle arthroscopy and identify significant predictors of SSI, using a multivariate analysis of demographic and clinical risk factors. Methods: This retrospective cohort study included 321 patients who underwent ankle arthroscopy between 2014 and 2022. Patients were excluded if they had pre-existing infections, open fractures, or incomplete medical records. Demographic and clinical data, including age, sex, BMI, smoking status, diabetes mellitus (DM), hypertension (SAH), and ASA score, were collected. The primary outcome was SSI incidence, with infections classified as superficial (managed conservatively) or deep (requiring surgical debridement or implant removal). Multivariate logistic regression was performed to identify independent predictors of infection, controlling for potential confounders. Statistical significance was set at p < 0.05. This study provides one of the largest long-term analyses on infection risk factors in ankle arthroscopy, offering critical insights into patient selection and perioperative management strategies. Results: The overall SSI incidence was 2.5% (8/321 patients), with 6 superficial and 2 deep infections requiring further surgery. Diabetes mellitus (DM) and high BMI emerged as independent predictors of infection. Patients with BMI ≥40 kg/m² had a 50% infection rate (p = 0.008), while DM patients had an 11.8% infection rate (p = 0.013). No significant associations were found with hypertension (p = 0.862), smoking (p = 0.254), ASA score (p = 0.616), or sex (p = 0.075). The most common indications for arthroscopy were synovectomy, impingement, and loose body removal (48.3%), followed by osteochondral defect treatment (16.8%) and ligament repair (12.8%). These findings suggest that BMI and DM should be considered in preoperative risk stratification. Conclusion: This 8-year study confirms that BMI and diabetes mellitus are independent predictors of postoperative infection in ankle arthroscopy, while other demographic factors, including hypertension, smoking, and ASA score, showed no significant correlation. Although the overall infection rate was low (2.5%), deep infections requiring surgical intervention reinforce the importance of early recognition and risk-based perioperative management. These findings support the implementation of targeted infection prevention strategies, particularly in patients with high BMI and diabetes, to optimize surgical outcomes and minimize complications. Preoperative screening and tailored postoperative care are essential to reducing infection risk in this patient population. Fisher’s Exact Test Results for Risk Factors Associated with Infection in Ankle Arthroscopy This table presents the association between clinical and demographic risk factors and surgical site infections (SSIs) following ankle arthroscopy. Diabetes mellitus (p = 0.013) and BMI (p = 0.008) were significantly associated with infection, indicating their role as independent risk factors. Other variables, including hypertension, smoking, gender, ASA score, and type of surgical procedure, did not show statistically significant associations (p > 0.05).