Stewart Matthew S, Bettin Clayton C, Ramsey Matthew T, Ishikawa Susan N, Murphy G Andrew, Richardson David R, Tolley Elizabeth A
Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
School of Medicine, University of Utah, Salt Lake City, UT, USA.
Foot Ankle Int. 2016 May;37(5):483-7. doi: 10.1177/1071100715624209. Epub 2016 Jan 7.
Forefoot surgery typically is elective, so it is important to define risk factors to educate patients on potential complications. The purpose of this study was to determine if obesity is an independent risk factor that contributes to increased complication rates after forefoot surgery.
Through a retrospective review of records, 633 patients were identified who had forefoot surgery at one institution between 2008 and 2010. All patients who currently smoked or smoked in the past were excluded to eliminate a confounding factor, as smoking is known to increase complication rates, leaving 427 patients for inclusion, 299 nonobese (BMI less than 30) and 128 obese (BMI more than 30). Medical records were reviewed for the occurrence of complications, including nonunion, delayed union, delayed wound healing, infection, and persistent pain.
The overall complication rate was 9%, with similar rates between obese (10%) and nonobese patients (9%). The only specific complication approaching significance (P = .13) was a higher rate of infection in obese patients (4 % compared to 1%), which could be attributed to the higher percentage of diabetic patients in the obese group. Diabetic patients, regardless of weight, had significantly higher rates of infection (P = .03), with a trend toward higher rates of overall complications and delayed wound healing (P = .08 and P < .06, respectively).
Obesity was not shown to lead to more frequent complications after forefoot surgery. Diabetes was associated with significantly higher rates of infection, regardless of weight. Though not significant, there was a trend toward higher rates of overall complications and delayed wound healing in diabetic patients as well.
Level III, retrospective comparative study.
前足手术通常属于择期手术，因此明确风险因素以告知患者潜在并发症很重要。本研究的目的是确定肥胖是否为导致前足手术后并发症发生率增加的独立风险因素。
通过回顾性查阅病历，确定了2008年至2010年间在一家机构接受前足手术的633例患者。所有目前吸烟或既往吸烟的患者均被排除，以消除一个混杂因素，因为已知吸烟会增加并发症发生率，最终纳入427例患者，其中299例非肥胖患者（体重指数小于30）和128例肥胖患者（体重指数大于30）。查阅病历以了解并发症的发生情况，包括骨不连、延迟愈合、伤口愈合延迟、感染和持续疼痛。
总体并发症发生率为9%，肥胖患者（10%）和非肥胖患者（9%）的发生率相似。唯一接近显著水平（P = 0.13）的特定并发症是肥胖患者的感染率较高（4%，而非肥胖患者为1%），这可能归因于肥胖组中糖尿病患者的比例较高。无论体重如何，糖尿病患者的感染率显著更高（P = 0.03），总体并发症和伤口愈合延迟的发生率有升高趋势（分别为P = 0.08和P < 0.06）。
未显示肥胖会导致前足手术后更频繁的并发症。糖尿病与显著更高的感染率相关，无论体重如何。尽管不显著，但糖尿病患者总体并发症和伤口愈合延迟的发生率也有升高趋势。
III级，回顾性比较研究。
