Patient adherence predicts ankle surgery healing

By Lynda Williams, Senior medwireNews Reporter

Focusing on postoperative care may be the optimal way of reducing healing complications following ankle fracture surgery, say US researchers.

The team from the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, reports that surgical debridement was required by just six (1.25%) of 478 patients who underwent open ankle reduction and internal fixation between 2003 and 2010. A further 14 (2.9%) patients needed additional wound dressing or oral antibiotics during healing.

Nevertheless, multivariate analysis identified several risk factors for postoperative wound complications among this population.

Specifically, patients were significantly more likely to have wound complications if they had diabetes (odds ratio [OR]=3.61) or an open fracture (OR=13.43), and if they used wound-compromising medications (OR=6.75), such as corticosteroids.

Furthermore, delayed wound healing was a significant 3.66 times more common in patients who were nonadherent to postoperative instructions, such as avoidance of weight bearing for at least 6 weeks, compared with patients who followed their physician's advice.

The risk for wound complications also rose significantly with increasing patient age, say Adam Miller and co-authors.

"While most risk factors cannot be controlled, postoperative care is an area of importance for wound-healing," writes the team. "The adherence to postoperative instructions should be emphasized, and the treating surgeon should remain vigilant to the potential effect that noncompliance may have on wound-healing after surgical intervention."

The researchers note in the US edition of the Journal of Bone and Joint Surgery that there was a trend toward an increased risk for wound complications in patients who underwent surgery within 5 days of injury compared with at a later date, but that this did not reach significance.

They were also unable to demonstrate any impact of preoperative swelling on the risk for wound complications in their study due to the subjective nature of the analysis.

Believing these two factors may nevertheless have significance in wound healing, they add: "This conjecture needs to be confirmed in a future randomized comparative study."

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