title: Effect of Obesity on Outcomes of Forefoot Surgery.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Stewart
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Clayton C
authors.initials: CC
authors.lastname: Bettin
authors.affiliation: School of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Ramsey
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Ishikawa
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
authors.forename: G Andrew
authors.initials: GA
authors.lastname: Murphy
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA drrichardson@campbellclinic.com.
authors.forename: David R
authors.initials: DR
authors.lastname: Richardson
authors.affiliation: Department of Biostatistics and Epidemiology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Tolley
mesh_terms: D048909:Diabetes Complications; D005260:Female; D005528:Foot / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: complications; diabetes; forefoot surgery; obesity