title: Outcomes of Foot and Ankle Surgery in Diabetic Patients Who Have Undergone Solid Organ Transplantation.
abstract: 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.
authors.affiliation: Medical Student, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Zou
authors.affiliation: 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. Electronic address: wukichdk@upmc.edu.
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
mesh_terms: D000842:Ankle / Q000601:surgery*; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005528:Foot / Q000601:surgery*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D063868:Patient Outcome Assessment; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications; D066027:Transplant Recipients
keywords: ankle; complication; diabetes mellitus; immunosuppression; risk; transplantation