Risk factors for foot and ankle disorders among assembly plant workers

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

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SAT0047 RISK FACTORS FOR THE POSTOPERATIVE DELAYED WOUND HEALING IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH A BIOLOGICAL AGENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3424 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 954.3-954

Author(s):

S. Okita ◽

H. Ishikawa ◽

A. Abe ◽

S. Ito ◽

A. Murasawa ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Wound Healing ◽

Retrospective Study ◽

Nutritional Status ◽

Disease Activity ◽

Disease Duration ◽

Foot And Ankle ◽

Delayed Wound Healing ◽

Chugai Pharmaceutical

Background:It has been suggested that perioperative use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in rheumatoid arthritis (RA) patients carries risks for the surgical-site infection and the delayed wound healing (DWH); however, the risk of DWH with perioperative use of bDMARDs has not reached a general consensus.Objectives:This retrospective study aimed to investigate the risk factors associated with DWH after orthopedic surgery in RA patients treated with bDMARDs.Methods:We reviewed medical records of 277 orthopedic procedures for 188 RA patients treated with bDMARDs between from 2014 to 2017 in Niigata Rheumatic Center. As preoperative nutritional status assessment, we evaluated body mass index (BMI), prognostic nutritional index (PNI), and CONtrolling NUTritional status (CONUT). In addition, we evaluated DAS28-CRP, DAS28-ESR, face scale for pain, global health (GH), and Health Assessment Questionnaire-Disability Index (HAQ-DI) to assess the disease activity. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factor for DWH.Results:The major characteristics of the patients in 277 procedures were mean age of 63.2 years old and mean disease duration of 18.2 years. Surgical site were hand and wrist (145 procedures), foot and ankle (76), hip and knee (31), elbow and shoulder (24), and spine (1). Seventy-four patients were treated with tocilizumab, 62 with etanercept, 55 with golimumab, 49 with abatacept, 16 with infliximab, 15 with adalimumab, and 6 with certolizumab. According to nutritional assessment in PNI and CONUT, 63% (n=175) and 47% (n=130) were normal nourished patients, respectively.In 277 procedures, DWH were identified in 24 patients (8.6%). The following variables were significant in the univariate analyses: disease duration (OR 1.053; 95% CI 1.010–1.099; p=0.016), foot and ankle surgery (OR 7.091; 95% CI 2.130–23.603; p=0.001), tocilizumab (OR 0.286; 95% CI 0.093–0.881; p=0.029) (Table 1). These variables were entered into a multivariate model, and it was revealed that pre-operative use of tocilizumab (OR 0.265; 95% CI 0.074–0.953; p=0.042) and procedures in the foot and ankle (OR 6.915; 95% CI 1.914–24.976; p=0.003) were associated with an increased risk of DWH (Table 1).Conclusion:As previous study on tocilizumab described, the current retrospective study suggested that pre-operative use of tocilizumab and procedures in the foot and ankle were risk factors for DWH. Pre-operative disease activity and nutritional status were not independent risk factors for an increase in the prevalence of DWH.References:[1] Momohara S, Hashimoto J, Tsuboi H et al. Analysis of perioperative clinical features and complications after orthopaedic surgery in rheumatoid arthritis patients treated with tocilizumab in a real-world setting: Results from the multicentre tocilizumab in perioperative period (TOPP) study. Modern rheumatology. 2013, 23: 440-9.Disclosure of Interests:Shunji Okita: None declared, Hajime Ishikawa: None declared, Asami Abe: None declared, Satoshi Ito Speakers bureau: Abbvie,Eisai, Akira Murasawa: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Toshifumi Ozaki: None declared

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Preoperative Risk Factors for Complications in Elective Ankle and Hindfoot Reconstruction

Foot & Ankle Specialist ◽

10.1177/1938640017706155 ◽

2017 ◽

Vol 11 (1) ◽

pp. 54-60 ◽

Cited By ~ 10

Author(s):

Ryan P. Mulligan ◽

Kevin J. McCarthy ◽

Benjamin J. Grear ◽

David R. Richardson ◽

Susan N. Ishikawa ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Chart Review ◽

Reoperation Rate ◽

Deep Infection ◽

Foot And Ankle ◽

Psychological Variables ◽

Reconstruction Methods ◽

Increased Risk ◽

Retrospective Comparative Study ◽

Alcohol Users

Background. The purpose of this study was to examine medical, social, and psychological factors associated with complications and reoperation after foot and ankle reconstruction. Methods. A retrospective chart review was conducted of 132 patients (135 feet; 139 operative cases) who had elective foot and ankle reconstruction. Medical, social, and psychological variables were documented. Primary outcomes included complications and reoperations. Results. The overall complication rate was 28% (39/139), and the reoperation rate was 17% (24/139). Alcohol use (P = .03) and preoperative narcotic use (P = .02) were risk factors for complications, with delayed wound healing more frequent in alcohol users (P = .03) and deep infection (P = .045) and nonunion (P = .046) more frequent preoperative narcotic use. Deep infection also was more frequent in tobacco users (P < .01). Older patients were less likely to undergo reoperation (risk of reoperation increased with age). Other variables were not associated with increased complications. Conclusion. Patients who consumed alcohol or had been prescribed any amount of narcotic within 3 months preoperatively were at increased risk for complications. Patients who smoked were more likely to have a wound infection. Surgeons should be aware of these factors and counsel patients before surgery. Levels of Evidence: Level III: Retrospective comparative study

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Incidence of and Risk Factors for Venous Thromboembolism After Foot and Ankle Surgery

Foot & Ankle Specialist ◽

10.1177/1938640018769740 ◽

2018 ◽

Vol 12 (3) ◽

pp. 218-227 ◽

Cited By ~ 6

Author(s):

Samuel R. Huntley ◽

Eildar Abyar ◽

Eva J. Lehtonen ◽

Harshadkumar A. Patel ◽

Sameer Naranje ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Female Gender ◽

Risk Groups ◽

Foot And Ankle ◽

Improvement Program ◽

True Incidence ◽

Ankle Surgery ◽

Data Files ◽

Retrospective Comparative Study

Background: Venous thromboembolism (VTE) is a rare but potentially lethal complication after orthopaedic foot and ankle surgery. The true incidence of VTE after orthopaedic foot and ankle surgery stratified by specific procedure has yet to be examined. The purpose of this study is to report the incidence of and identify risk factors for VTE in a large sample of patients receiving orthopaedic foot and ankle surgery. Methods: In this study, we retrospectively analyzed data from the National Surgical Quality Improvement Program 2006 to 2015 data files. The incidence of VTE was calculated for 30 specific orthopaedic foot and ankle surgeries and for 4 broad types of foot and ankle surgery. Demographic, comorbidity, and complication variables were analyzed to determine associations with development of VTE. Results: The overall incidence of VTE in our sample was 0.6%. The types of procedures with the highest frequency of VTE were ankle fractures (105/15 302 cases, 0.7%), foot pathologies (28/5466, 0.6%), and arthroscopy (2/398, 0.5%). Female gender, increasing age, obesity, inpatient status, and nonelective surgery were all significantly associated with VTE. Conclusion: Although VTE after orthopaedic foot and ankle surgery is a rare occurrence, several high-risk groups and procedures may be especially indicated for chemical thromboprophylaxis. Levels of Evidence: Level III: Retrospective, comparative study

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Current Concepts Review: Risk Factors for Nonunions in Foot and Ankle Arthrodeses

Foot & Ankle International ◽

10.3113/fai.2012.1031 ◽

2012 ◽

Vol 33 (11) ◽

pp. 1031-1040 ◽

Cited By ~ 31

Author(s):

Gowreeson Thevendran ◽

Alastair Younger ◽

Stephen Pinney

Keyword(s):

Risk Factors ◽

Foot And Ankle

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Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01972-4 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jinghong Meng ◽

Yanbin Zhu ◽

Yansen Li ◽

Tao Sun ◽

Fengqi Zhang ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Retrospective Study ◽

Surgical Site Infection ◽

Elective Surgery ◽

Site Infection ◽

Foot And Ankle ◽

Coagulase Negative Staphylococci ◽

Methicillin Resistant ◽

Associated Risk Factors

Abstract Background This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors. Methods This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI. Results A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12). Conclusions SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.

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Association of Abnormal Metatarsal Parabola With Second Metatarsophalangeal Joint Plantar Plate Pathology

Foot & Ankle International ◽

10.1177/1071100716674671 ◽

2016 ◽

Vol 38 (3) ◽

pp. 289-297 ◽

Cited By ~ 14

Author(s):

Adam E. Fleischer ◽

Erin E. Klein ◽

Maheen Ahmad ◽

Shivang Shah ◽

Fernanda Catena ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Conditional Logistic Regression ◽

Weight Bearing ◽

Metatarsophalangeal Joint ◽

Control Group ◽

X Rays ◽

Foot And Ankle ◽

Plantar Plate ◽

Second Metatarsal

Background: Plantar plate pathology is common, yet it is unclear whether, and to what extent, the length of the second metatarsal contributes to this problem. Methods: We conducted a retrospective case-control (1:2) study to examine radiographic risk factors for plantar plate tears. One hundred patients (age 55.7 ± 12.3 years) with plantar plate injuries and 200 healthy controls (age 56.3 ± 11.3 years) were included. Cases were defined as patients with nonacute, isolated, plantar plate pathology of the second metatarsophalangeal joint confirmed by intraoperative inspection at a single foot and ankle specialty practice from June 1, 2007, to January 31, 2014. Patients presenting for pain outside of the forefoot served as the control group. Controls were matched on age (±2 years), gender, and year of presentation. Weight-bearing foot x-rays were assessed for several predetermined angular relationships by a single rater. Conditional logistic regression was used to identify risk factors for plantar plate injury. Results: A long second metatarsal, defined as a metatarsal protrusion index less than −4 mm, was the only significant risk factor for plantar plate pathology in both the univariate and multivariable analyses (multivariate odds ratio 2.5 [95% confidence interval 1.8 to 3.3], P = .002). Conclusion: We found that a long second metatarsal was a risk factor for developing second metatarsophalangeal joint plantar plate tears. This knowledge may aid foot and ankle surgeons when contemplating the need for second metatarsal shortening osteotomies (eg, Weil osteotomy) during plantar plate surgery and when deciding on the amount of shortening for second metatarsal osteotomies. Level of Evidence: Level III, retrospective comparative study.

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´Feet are second class citizens`: exploring the perceptions of Scottish and Portuguese older adults about feet, falls and exercise- a qualitative study

Journal of Foot and Ankle Research ◽

10.1186/s13047-020-00434-8 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Monserrat Conde ◽

Gordon J. Hendry ◽

Jim Woodburn ◽

Dawn A. Skelton

Keyword(s):

Risk Factors ◽

Older Adults ◽

Qualitative Study ◽

Community Dwelling ◽

Falls Prevention ◽

Main Theme ◽

Foot And Ankle ◽

Falls Risk ◽

Risk Factors For Falls

Abstract Introduction Foot problems are likely to contribute to falls risk in older adults. Foot and ankle exercises may be beneficial, but uptake may be influenced by cultural factors. Few studies have explored the views of older adults from different cultural backgrounds about foot-specific falls risk factors, and foot and ankle falls prevention exercises. Objectives To explore the views of Scottish and Portuguese community-dwelling older adults who have experienced a fall, about any foot risk factors for falls, and foot and ankle exercises. Methods Cross-cultural qualitative study with (n = 6) focus groups exploring the perceptions of Scottish (n = 10, mean age 76 yrs) and Portuguese older adults (n = 14, mean age 66 years) aged, applying thematic analysis. Results One main theme `evolving awareness about feet and falls prevention´ and three subthemes; (i) Feet are often forgotten, (ii) the important role of footwear, (iii) need to look at my feet and do the exercises were identified. Scottish participants had more experience of falls prevention but there was a lack of knowledge surrounding foot-specific falls risk factors, and the role of ankle and foot exercise in the prevention of falls. Portuguese participants exhibited a fatalistic approach to falls. Conclusions Older adults from both nations had little knowledge of foot-specific falls risk factors, being initially unaware of the functional status of their feet and of the role of exercise in foot care and falls management. There were differences between national groups that should be accounted for when developing culturally adequate interventions.

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Subsequent Pain or Injury After Foot and Ankle Surgery in Patients Receiving Workers’ Compensation

Foot & Ankle International ◽

10.1177/1071100719879648 ◽

2019 ◽

Vol 41 (1) ◽

pp. 17-24

Author(s):

Gabrielle Bui ◽

Yubo Gao ◽

Natalie Glass ◽

Christopher Cychosz ◽

John Lawrence Marsh ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Retrospective Chart Review ◽

Anatomical Location ◽

Workers Compensation ◽

Foot And Ankle ◽

Chi Square ◽

Level Of Evidence ◽

Legal Representation ◽

Ankle Surgery

Background: Workers’ compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries, but rates of subsequent pain or injury (SPI) following surgery have not been studied. The purpose of this study was to investigate the rates, locations, and risk factors of SPI in WC patients and non-WC patients who underwent the same surgeries. Methods: With institutional review board approval, records from foot or ankle surgery performed by author P.P. from 2009 to 2015 were obtained. A retrospective chart review was performed on all WC and non-WC patients with at least 1 Current Procedural Terminology code of interest. SPI was defined as a new injury at a different anatomical location occurring 2 months to 2 years after the index surgery. Chi-square and 2-tailed t tests were used to compare risk factors and rates of SPI in both groups. Results: The WC population had higher rates of SPI than the non-WC population. Specifically, 13 of 56 WC patients (23.2%) vs 12 of 165 non-WC patients (7.3%) reported SPI ( P = .001). The hip, knee, and contralateral foot and ankle were common areas of SPI in both groups. Legal representation and increased age were risk factors for SPI in the WC population. Specifically, 10 of 13 WC patients with SPI had legal representation vs 16 of 43 WC patients without SPI ( P = .02). Female sex was a risk factor for SPI in the non-WC population. Conclusions: WC patients had higher rates of subsequent pain or injury than non-WC patients. Legal representation was a risk factor for SPI in the WC population. Level of Evidence: Level III, comparative series.

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Opioid Consumption Rate After Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00004 ◽

2019 ◽

Vol 4 (2) ◽

pp. 2473011419S0000

Author(s):

Peter Kvarda ◽

Noortje Hagemeijer ◽

Gregory R. Waryasz ◽

Daniel Guss ◽

Christopher W. DiGiovanni ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Pain ◽

Soft Tissue ◽

Consumption Rate ◽

Opioid Consumption ◽

Foot And Ankle ◽

Soft Tissue Procedure ◽

Ankle Surgery ◽

Ed Visits ◽

Telephone Calls

Category: Opioid consumption rate and risk factors investigation after foot and ankle surgery Introduction/Purpose: The rapid increase in the consumption of prescription opioids has become one of the leading medical, economical, and sociological burdens in North America. In the United States, orthopedic surgery is the fourth leading specialty in the number of opioids prescribed, and the largest among surgical specialties. There is insufficient evidence to guide surgeons about appropriate opioid prescription amounts after orthopaedic foot and ankle (F&A) procedures. The aim of this study was to determine the opioid consumption rate after foot and ankle procedures, and to identify patient risk factors associated with higher use. Methods: A total of 535 patients who underwent a F&A surgery performed by one orthopedic surgeon from August 2016 to March 2018 were investigated. The study was approved by our IRB. Each patient received a preoperative discussion about postoperative pain and expectations alongside a standardized handout. At the two-week postoperative visit, the patient-reported amount of consumed opioids was recorded. Prescription details, the amount of opioids taken, refill requests, pain-issue related telephone calls, and additional MD/ED visits were also documented. Patient demographics and co-morbidities, use of regional anesthesia, postoperative inpatient hospitalization, surgery type and severity, and pre-operative opioid use were collected retrospectively. Total amounts of morphine equivalents were calculated and converted into oxycodone 5 mg pills for standardization. P-values of <0.05 were considered significant. Results: Two hundred forty-four patients with a mean age of 50 years (±16.3) and a BMI of 29 (±6.1) were included. Sixty-six (27%) patients underwent a soft tissue procedure alone and 178 (73%) underwent a bony procedure. 225 (92.2%) patients received regional block. Patients reported that they consumed only 51.2% of prescribed pills after a bony procedure and 42.4% after a soft tissue procedure, respectively, which resulted in a total of 4,496.2 left over pills that derived from this study amongst only 244 patients enrolled. There were 11 refill requests (4.5%), two (0.8%) additional MD/ED visits, and 19 (7.8%) telephone calls related to pain. BMI, procedure type, and number of opioids prescribed were positively correlated with the consumption rate (P =.002, P<.001, P<0.001, respectively). Conclusion: BMI, surgery type (bony vs. soft tissue), and a higher number of pills dispensed were correlated with higher use in the postoperative period. After an educative discussion on postoperative pain, patients took 42.4% of the prescribed opioid after soft tissue procedures and 51.2% after bony procedures, resulting in a significant number of unused pills now available to the community. Future guidelines are necessary to improve our postoperative pain management, but this study suggests that current amounts of dispensed pills after orthopaedic F&A procedures are approximately twice as high as necessary.

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