title: Effect of Obesity on Outcome of Hallux Valgus Surgery.
abstract: BACKGROUND
  Obesity is a global epidemic, but its effect on foot and ankle surgeries is not well defined. This study aimed to investigate the influence of obesity on functional outcome scores, incidence of postoperative surgical site infection (SSI), and repeat surgery after hallux valgus (HV) corrective surgery.
  
  
  METHODS
  Between January 2007 and December 2011, 452 patients who underwent HV corrective surgery at a tertiary hospital were evaluated. They were categorized into 2 groups based on their body mass index (BMI): (1) BMI less than 30 kg/m(2) (control); (2) BMI 30 kg/m(2) or more (obese). The patients were prospectively followed for 2 years.
  
  
  RESULTS
  Patients in the obese group were significantly older by 4 years (95% CI, 1-7 years) (P = .043). The preoperative American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) Scale and Physical Component Score were 6 points (95% CI, 1-11 points) and 3 points (95% CI, 1-6 points) poorer, respectively, in the obese group (P = .014 and P = .032, respectively). However, the Visual Analog Scale, AOFAS Hallux MTP-IP Scale, Physical Component Score, and Mental Component Score were comparable between the 2 groups at 6 months and 2 years of follow-up (all P > .05). Eleven patients (3%) in the control group and 1 patient in the obese group (2%) developed postoperative SSI (P = .777). Nine patients (2%) in the control group and 7 patients in the obese group (14%) required repeat surgery for complications (P < .001).
  
  
  CONCLUSIONS
  The authors conclude that while it is important to warn obese patients of the significantly higher risk of repeat surgery, these patients should not be excluded from undergoing HV surgery.
  
  
  METHODS
  Level III, retrospective comparative series.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore yqjchen@gmail.com.
authors.forename: Jerry Yongqiang
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Merrill Jian Hui
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Kiran
authors.initials: K
authors.lastname: Rikhraj
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Simran
authors.initials: S
authors.lastname: Parmar
authors.affiliation: Department of Physiotherapy, Singapore General Hospital, Singapore.
authors.forename: Hwei Chi
authors.initials: HC
authors.lastname: Chong
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Andy Khye Soon
authors.initials: AK
authors.lastname: Yew
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Kevin Oon Thien
authors.initials: KO
authors.lastname: Koo
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Inderjeet
authors.initials: I
authors.lastname: Singh Rikhraj
mesh_terms: D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D010027:Osteotomy / Q000706:statistics & numerical data; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012846:Singapore / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: body mass index; functional outcome; hallux valgus; obesity; repeat surgery