University of Pittsburgh Medical Center Comprehensive Foot and Ankle Center, Pittsburgh, PA, USA.
J Bone Joint Surg Am. 2010 Feb;92(2):287-95. doi: 10.2106/JBJS.I.00080.
Patients with diabetes mellitus may be at increased risk for infection following foot and ankle surgery. This study aimed to determine whether patients with a diagnosis of diabetes mellitus have an increased rate of infection following foot and ankle surgery compared with a cohort of patients without diabetes. Furthermore, our study sought to demonstrate whether patients with complicated diabetes are at greater risk of postoperative wound infection than are patients with uncomplicated diabetes or patients without diabetes.
We conducted a retrospective review of the charts of 1000 patients who had orthopaedic foot and ankle surgery. The following data were extracted: patient age, sex, history of diabetes mellitus, development of postoperative infection, severity of infection, inpatient or outpatient surgery, use of internal or external fixation, tobacco use, history of organ transplantation, history of rheumatoid arthritis, length of surgery, follow-up time in weeks, and comorbid conditions.
The overall infection rate in this study was 4.8%. Fifty-two percent of all infections occurred in our diabetic study group, which represented only 19% of the patient population. Postoperative infections occurred in significantly more persons with diabetes (13.2%) than in those without diabetes (2.8%). Diabetic patients were five times more likely to experience a severe infection requiring hospitalization compared with patients without diabetes. After removing the patients with neuropathy from the analysis, there was no longer a significant association between diabetes and infection. The presence of complicated diabetes increased the risk of postoperative infection by a factor of ten compared with the risk for patients without diabetes and by a factor of six compared with the risk for patients with uncomplicated diabetes. We did not identify a significantly increased risk of infection in patients with uncomplicated diabetes compared with that in patients without diabetes.
Patients with diabetes mellitus are at increased risk of severe infection compared with those without diabetes. Patients with uncomplicated diabetes did not have an increased risk of postoperative infection compared with patients without diabetes, whereas patients with complicated diabetes had a significantly higher rate of postoperative infection.
糖尿病患者在足部和踝关节手术后可能面临更高的感染风险。本研究旨在确定与无糖尿病患者相比，患有糖尿病的患者在足部和踝关节手术后的感染率是否更高。此外，我们的研究旨在证明，与无糖尿病或无糖尿病的患者相比，患有复杂糖尿病的患者是否有更高的术后伤口感染风险。
我们对 1000 例接受骨科足部和踝关节手术的患者的病历进行了回顾性分析。提取了以下数据：患者年龄、性别、糖尿病史、术后感染发生情况、感染严重程度、住院或门诊手术、内固定或外固定使用、吸烟史、器官移植史、类风湿关节炎史、手术时间、随访时间（周）和并存疾病。
本研究的总体感染率为 4.8%。所有感染中，52%发生在我们的糖尿病研究组，而该组仅占患者人群的 19%。糖尿病患者术后感染发生率（13.2%）明显高于非糖尿病患者（2.8%）。与非糖尿病患者相比，糖尿病患者发生严重感染需要住院治疗的可能性高 5 倍。从分析中去除神经病变患者后，糖尿病与感染之间不再存在显著关联。与非糖尿病患者相比，复杂糖尿病患者术后感染的风险增加了 10 倍，与单纯糖尿病患者相比，感染的风险增加了 6 倍。我们没有发现单纯糖尿病患者的感染风险与非糖尿病患者相比有显著增加。
与非糖尿病患者相比，糖尿病患者发生严重感染的风险增加。与非糖尿病患者相比，单纯糖尿病患者术后感染的风险没有增加，而复杂糖尿病患者术后感染的风险显著增加。
