Advertisement

Medical comorbidities increase the rate of surgical site infection in primary Achilles tendon repair

  • Malcolm Dombrowski
  • Christopher D. Murawski
  • Youichi Yasui
  • Antonia F. Chen
  • Samuel O. Ewalefo
  • Mitchell S. Fourman
  • John G. Kennedy
  • MaCalus V. HoganEmail author
ANKLE
  • 34 Downloads

Abstract

Purpose

To assess the effects of medical comorbidities on the incidence of surgical site infection following primary Achilles tendon repair. A secondary aim was to assess the effects of specific medical comorbidities on the cost and extent of healthcare utilization related to surgical site infection following primary Achilles tendon repair.

Methods

24,269 patients undergoing primary Achilles tendon repair between 2005 and 2012 were examined. Current Procedural Terminology codes for primary Achilles tendon repair, and incision and drainage were used to search for and compile patient data from the United Healthcare Orthopedic and Medicare databases. Primary outcome measures regarding surgical site infection following primary Achilles tendon repair included the rate of occurrence, cost, and duration of treatment.

Results

Patients with one or more preexisting medical comorbidities at the time of surgery had an increased rate of surgical site infection compared to those without. Diabetes and vascular complications were associated with the highest surgical site infection rates. The rate of surgical incision and drainage was higher in patients with cardiac arrhythmias and uncomplicated hypertension. The presence of a medical comorbidity significantly increased the cost and duration of surgical site infection treatment.

Conclusions

Medical comorbidities can complicate the postoperative course for patients undergoing Achilles tendon repair, which increases the cost of care and duration of treatment. A better understanding of the relationship between each medical comorbidity and surgical site infections following Achilles tendon repair may be ascertained with additional prospective studies, thus, allowing for a more accurate evaluation and stratification of surgical candidates to improve patient outcomes.

Level of evidence

Retrospective cohort study, Level III.

Keywords

Achilles tendon rupture Surgical site infection Comorbidity 

Abbreviations

SSI

Surgical site infection

HIPAA

Health Insurance Portability and Accountability

CPT

Current procedural terminology

ICD-9

International classification of disease, ninth revision

I&D

Incision and drainage

OR

Odds ratio

CI

Confidence interval

Notes

Acknowledgements

All individuals who have contributed to this article are listed as authors.

Author contributions

MD, CM, and MH contributed to the design, data acquisition, analysis and interpretation of data for this article. YY and AC contributed to the data acquisition, analysis, and interpretation of data for this article. SE and JK contributed to the analysis and interpretation of data, drafting, and critical revision of the manuscript.

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

The author declares that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of database, formal consent is not required.

References

  1. 1.
    Bhandari M, Guyatt GH, Siddiqui F et al (2002) Treatment of acute Achilles tendon ruptures: a systematic overview and meta-analysis. Clin Orthop Relat Res 400:190–200CrossRefGoogle Scholar
  2. 2.
    Bruggeman NB, Turner NS, Dahm DL et al (2004) Wound complications after open Achilles tendon repair: an analysis of risk factors. Clin Orthop Relat Res 427:63–66CrossRefGoogle Scholar
  3. 3.
    Budny AM, Ley AN (2015) Fluoroquinolone-mediated Achilles rupture: a case report and review of the literature. J Foot Ankle Surg 54(3):494–496CrossRefGoogle Scholar
  4. 4.
    Burrus MT, Werner BC, Park JS, Perumal V, Cooper MT (2016) Achilles tendon repair in obese patients is associated with increased complication rates. Foot Ankle Spec 9(3):208–214CrossRefGoogle Scholar
  5. 5.
    Carmont MR, Heaver C, Pradhan A, Mei-Dan O, Gravare Silbernagel K (2013) Surgical repair of the ruptured Achilles tendon: the cost-effectiveness of open versus percutaneous repair. Knee Surg Sports Traumatol Arthrosc 21(6):1361–1368CrossRefGoogle Scholar
  6. 6.
    Chahal GS, Saithna A, Brewster M et al (2013) A comparison of complications requiring return to theatre in hip and knee arthroplasty patients taking enoxaparin versus rivaroxaban for thromboprophylaxis. Orthop Traumatol Rehabil 15(2):125–129Google Scholar
  7. 7.
    Goel DP, Chan D, Watson K, Mohtadi N (2009) Safety and hospital costs of Achilles tendon surgery: the serendipitous impact of a randomized clinical trial. Can J Surg 52(6):467–472PubMedPubMedCentralGoogle Scholar
  8. 8.
    Gwynne-Jones DP, Sims M, Handcock D (2011) Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol. Foot Ankle Int 32(4):337–343CrossRefGoogle Scholar
  9. 9.
    Huttunen TT, Kannus P, Rolf C, Fellander-Tsai L, Mattila VM (2014) Acute Achilles tendon ruptures: incidence of injury and surgery in Sweden between 2001 and 2012. Am J Sports Med 42(10):2419–2423CrossRefGoogle Scholar
  10. 10.
    Jameson SS, Rymaszewska M, Hui AC, James P, Serrano-Pedraza I, Muller SD (2012) Wound complications following rivaroxaban administration: a multicenter comparison with low-molecular-weight heparins for thromboprophylaxis in lower limb arthroplasty. J Bone Jt Surg Am 94(17):1554–1558CrossRefGoogle Scholar
  11. 11.
    Khan RJ, Carey Smith RL (2010) Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev 9:CD003674Google Scholar
  12. 12.
    Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M (2005) Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Jt Surg Am 87(10):2202–2210Google Scholar
  13. 13.
    Lantto I, Heikkinen J, Flinkkila T, Ohtonen P, Leppilahti J (2015) Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports 25(1):e133–e138CrossRefGoogle Scholar
  14. 14.
    Menendez ME, Neuhaus V, van Dijk CN, Ring D (2014) The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res 472(9):2878–2886CrossRefGoogle Scholar
  15. 15.
    Moller M, Movin T, Granhed H, Lind K, Faxen E, Karlsson J (2001) Acute rupture of tendon Achilles. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Jt Surg Br 83(6):843–848CrossRefGoogle Scholar
  16. 16.
    Murison MS, Eardley I, Slapak M (1989) Tendinitis—a common complication after renal transplantation. Transplantation 48(4):587–589PubMedGoogle Scholar
  17. 17.
    Newnham DM, Douglas JG, Legge JS, Friend JA (1991) Achilles tendon rupture: an underrated complication of corticosteroid treatment. Thorax 46(11):853–854CrossRefGoogle Scholar
  18. 18.
    Nyyssonen T, Luthje P, Kroger H (2008) The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987–1999. Scand J Surg 97(3):272–275CrossRefGoogle Scholar
  19. 19.
    Strauss EJ, Ishak C, Jazrawi L, Sherman O, Rosen J (2007) Operative treatment of acute Achilles tendon ruptures: an institutional review of clinical outcomes. Injury 38(7):832–838CrossRefGoogle Scholar
  20. 20.
    Twaddle BC, Poon P (2007) Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med 35(12):2033–2038CrossRefGoogle Scholar
  21. 21.
    Wilkins R, Bisson LJ (2012) Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials. Am J Sports Med 40(9):2154–2160CrossRefGoogle Scholar
  22. 22.
    Willits K, Amendola A, Bryant D et al (2010) Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Jt Surg Am 92(17):2767–2775CrossRefGoogle Scholar
  23. 23.
    Worth N, Ghosh S, Maffulli N (2007) Management of acute Achilles tendon ruptures in the United Kingdom. J Orthop Surg (Hong Kong) 15(3):311–314CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Malcolm Dombrowski
    • 1
  • Christopher D. Murawski
    • 1
  • Youichi Yasui
    • 2
    • 3
  • Antonia F. Chen
    • 4
  • Samuel O. Ewalefo
    • 1
  • Mitchell S. Fourman
    • 1
  • John G. Kennedy
    • 3
  • MaCalus V. Hogan
    • 1
    Email author
  1. 1.Foot and Ankle Injury Research [F.A.I.R.] group, Department of Orthopaedic SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of Orthopaedic SurgeryTeikyo University School of MedicineTokyoJapan
  3. 3.Department of Foot and Ankle SurgeryHospital for Special SurgeryNew YorkUSA
  4. 4.Department of Orthopaedic Surgery, Harvard Medical SchoolBrigham and Women’s HospitalBostonUSA

Personalised recommendations