Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2019

01-09-2019 | Achilles Tendon Rupture | ANKLE

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

Authors: Malcolm Dombrowski, Christopher D. Murawski, Youichi Yasui, Antonia F. Chen, Samuel O. Ewalefo, Mitchell S. Fourman, John G. Kennedy, MaCalus V. Hogan

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2019

Login to get access

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.
Appendix
Available only for authorised users
Literature
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 400:190–200CrossRef
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 427:63–66CrossRef
3.
Budny AM, Ley AN (2015) Fluoroquinolone-mediated Achilles rupture: a case report and review of the literature. J Foot Ankle Surg 54(3):494–496CrossRefPubMed
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):208–214CrossRefPubMed
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):1361–1368CrossRefPubMed
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):125–129
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):467–472PubMedPubMedCentral
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):337–343CrossRefPubMed
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):2419–2423CrossRefPubMed
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):1554–1558CrossRef
11.
Khan RJ, Carey Smith RL (2010) Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev 9:CD003674
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):2202–2210
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–e138CrossRefPubMed
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):2878–2886CrossRefPubMedPubMedCentral
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):843–848CrossRef
16.
Murison MS, Eardley I, Slapak M (1989) Tendinitis—a common complication after renal transplantation. Transplantation 48(4):587–589PubMed
17.
Newnham DM, Douglas JG, Legge JS, Friend JA (1991) Achilles tendon rupture: an underrated complication of corticosteroid treatment. Thorax 46(11):853–854CrossRefPubMedPubMedCentral
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):272–275CrossRefPubMed
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):832–838CrossRefPubMed
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):2033–2038CrossRefPubMed
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):2154–2160CrossRefPubMed
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):2767–2775CrossRef
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):311–314CrossRef
Metadata
Title
Medical comorbidities increase the rate of surgical site infection in primary Achilles tendon repair
Authors
Malcolm Dombrowski
Christopher D. Murawski
Youichi Yasui
Antonia F. Chen
Samuel O. Ewalefo
Mitchell S. Fourman
John G. Kennedy
MaCalus V. Hogan
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5295-6

Other articles of this Issue 9/2019

Knee Surgery, Sports Traumatology, Arthroscopy 9/2019 Go to the issue

KNEE

A proposal for a new classification of pes anserinus morphology

KNEE

Bone autografting in medial open wedge high tibial osteotomy results in improved osseous gap healing on computed tomography, but no functional advantage: a prospective, randomised, controlled trial

ANKLE

MRI for high ankle sprains with an unstable syndesmosis: posterior malleolus bone oedema is common and time to scan matters

Knee

The OARSI core set of performance-based measures for knee osteoarthritis is reliable but not valid and responsive

KNEE

Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction

Ankle

High reported rate of return to play following bone marrow stimulation for osteochondral lesions of the talus