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



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.


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.


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.


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.


Achilles tendon rupture Surgical site infection Comorbidity 



Surgical site infection


Health Insurance Portability and Accountability


Current procedural terminology


International classification of disease, ninth revision


Incision and drainage


Odds ratio


Confidence interval



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.


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.


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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

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