Not All Patients With Diabetes are at High Risk for Surgical Complications

Contact: Richard Cantrall 800.235.4855

Doug Cavarocchi

For Release 17 July 1997

Recent research defies conventional wisdom:

Not all patients with diabetes are at high risk for surgical complications

MONTEREY -- New information reported at the American Orthopaedic Foot and Ankle Society's (AOFAS) 13th Annual Summer Meeting will allow surgeons to treat more people with diabetes -- a population group popularly thought too risky for surgery -- normally and without fear of serious complications. The study, which examined six variables commonly thought to indicate a significant risk of surgical complications in patients with diabetes, revealed that in actuality only two of these variables are reliable indicators of future problems.

"Many physicians hesitate to treat diabetic patients with severe ankle fratures surgically for fear of complications. This information allows doctors to more accurately identify which diabetic patients are prone to complications," explained William Costigan, MD, University of Southern California, and an author of this study. "More importantly, this improved understanding of diabetic risk factors permits the surgeon to treat most diabetic patients as they would any other patient."

Researchers evaluated patients with peripheral vascular disease (as evidenced by a lack of pulse in the foot), neuropathy (a nerve disorder, common to diabetics, that results in a loss of sensation in the foot), insulin dependence, hypertension, advanced age and nephropathy (renal dysfunction), to test if patients afflicted with these conditions were predisposed to complications following surgery. Only those patients with vascular disease and neuropathy were shown to be significantly more likely to suffer complications as a result of their surgeries.

The authors of the study examined 52 diabetic patients who suffered traumatic ankle fractures which were repaired surgically and with the use of screws or other hardware to hold the joint in place as it healed, a procedure known as open reduction internal fixation (ORIF). This surgical procedure is commonly used as an alternative to immobilizing the ankle in a cast. Many physicians feel that surgical repair of these fractures promotes more rapid and complete healing.

Surgical complications can include minor exterior infections and more dangerous deep infections. Patients can also suffer a decrease of function in the afflicted joint, and a change in their gait, according to Dr. Costigan, but deep infections pose the greatest danger.

"Deep infections can cause a patient to take three times longer to recover from surgery, and if the infection is severe enough, it could warrant amputation of the limb." he explained. Identifying those patients who truly are at high risk and recognizing their predisposition for serious complications, allows physicians to take precautions and protect these patients. Helping high risk patients avoid complications ultimately cuts recovery time by two-thirds, reduces time of convalescence, lowers overall healthcare costs, and in some cases saves lower limbs from surgical removal.

Dr. Costigan noted that in certain instances, surgical treatment of these injuries is unavoidable regardless of the risks of complications. "In cases where the patient is obviously of the high risk group, but surgical repair of the fracture is a must, the physician should alter his or her surgical technique to minimize incisions and use as little hardware in the repair as possible," he said.

The authors also emphasized that special care be given to high risk patients after surgery is completed. Diabetic patients with neuropathy or vascular disease should expect to spend a longer period of time off their ankle to allow it to fully heal before they expect it to bear any weight, and physicians should be especially diligent in caring for the surgical wounds of these high risk patients.

Dr. Costigan was assisted in the collection of data and the writing of this report by David B. Thordarson, MD, Associate Professor of Orthopaedics, University of Southern California, Los Angeles.

Dedicated to advancing research and educational objectives in foot and ankle care, the American Orthopaedic Foot and Ankle Society is the leading organization for orthopaedists with a special interest in foot and ankle problems.

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Press and patient information available at: http://www.aofas.org