Zou Richard H, Wukich Dane K
Medical Student, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Professor, Department of Orthopaedic Surgery; Chief, Division of Foot and Ankle Surgery; Professor, Rehabilitation Science and Technology; Medical Director, Mercy Center for Healing and Amputation Prevention; and Medical Director, Comprehensive Foot and Ankle Center, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Foot Ankle Surg. 2015 Jul-Aug;54(4):577-81. doi: 10.1053/j.jfas.2014.10.003. Epub 2014 Dec 5.
Foot and ankle problems are highly prevalent in patients with diabetes mellitus (DM). Increased rates of surgical site infections and noninfectious complications, such as malunion, delayed union, nonunion, and hardware failure, have also been more commonly observed in diabetic patients who undergo foot and ankle surgery. DM is a substantial contributor of perioperative morbidity in patients with solid organ transplantation. To the best of our knowledge, postoperative foot and ankle complications have not been studied in a cohort of diabetic patients who previously underwent solid organ transplantation. The aim of the present study was to evaluate the outcomes of foot and ankle surgery in a cohort of diabetic transplant patients and to compare these outcomes with those of diabetic patients without a history of transplantation. We compared the rates of infectious and noninfectious complications after foot and ankle surgery in 28 diabetic transplant patients and 56 diabetic patients without previous transplantation and calculated the odds ratios (OR) for significant findings. The diabetic transplant patients who underwent foot and ankle surgery in the present cohort were not at an increased risk of overall complications (OR 0.83, 95% confidence interval [CI] 0.33 to 2.08, p = .67), infectious complications (OR 0.54, 95% CI 0.09 to 3.09, p = .49), or noninfectious complications (OR 1.14, 95% CI 0.41 to 3.15, p = .81). Four transplant patients (14.3%) died of non-orthopedic surgery-related events during the follow-up period; however, no deaths occurred in the control group. Diabetic patients with previous solid organ transplantation were not at an increased risk of developing postoperative complications after foot and ankle surgery, despite being immunocompromised. The transplant patients had a greater mortality rate, but their premature death was unrelated to their foot and ankle surgery. Surgeons treating transplant patients can recommend foot and ankle surgery when indicated. However, owing to the increased mortality rate and comorbidities associated with this high-risk group, we recommend preoperative clearance from the transplant team and medical consultations before performing surgery.
足踝问题在糖尿病患者中极为普遍。手术部位感染以及诸如骨愈合不良、延迟愈合、不愈合和内固定失败等非感染性并发症的发生率，在接受足踝手术的糖尿病患者中也更为常见。糖尿病是实体器官移植患者围手术期发病的一个重要因素。据我们所知，尚未对先前接受过实体器官移植的糖尿病患者队列中的术后足踝并发症进行研究。本研究的目的是评估一组糖尿病移植患者足踝手术的结果，并将这些结果与无移植史的糖尿病患者的结果进行比较。我们比较了28例糖尿病移植患者和56例无移植史的糖尿病患者足踝手术后感染性和非感染性并发症的发生率，并计算了显著发现的比值比（OR）。本队列中接受足踝手术的糖尿病移植患者总体并发症（OR 0.83，95%置信区间[CI] 0.33至2.08，p = 0.67）、感染性并发症（OR 0.54，95% CI 0.09至3.09，p = 0.49）或非感染性并发症（OR 1.14，95% CI 0.41至3.15，p = 0.81）的风险并未增加。4例移植患者（14.3%）在随访期间死于非骨科手术相关事件；然而，对照组未发生死亡。尽管先前接受过实体器官移植的糖尿病患者免疫功能低下，但他们在足踝手术后发生术后并发症的风险并未增加。移植患者的死亡率更高，但其过早死亡与足踝手术无关。治疗移植患者的外科医生在有指征时可推荐足踝手术。然而，由于该高危人群的死亡率增加和合并症较多，我们建议在手术前获得移植团队的术前许可并进行内科会诊。
