Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Foot and ankle injuries are common injuries, but certain populations are more prone to these injuries than others. Due to their organ dysfunctions and effects from immunosuppressive regimens, solid organ transplant patients (SOT) seem to be more prone to injury and complications from treatment. However, currently there is nothing in the literature reporting on these injuries or the treatment outcomes in this population, which was the purpose of this study.
Methods:
This was a retrospective case control study performed at a single institution to investigate post-operative outcomes of SOT patients undergoing foot and ankle procedures after injury. Current procedural terminology codes (CPT) codes were used to identify patients, and their healthy, non-SOT matched controls and charts were reviewed for infection, nonunion, pain, wound dehiscence, transfusion, readmission, reoperation, discharge disposition, hospital length of stay (LOS), operative time, and time to union/release from post-operative precautions was compared between the two groups. Statistical analysis was performed using two sample t-tests, Chi-square (or Fischer’s exact tests) and ANOVA when appropriate for continuous or categorical data.
Results:
In a study of 120 patients (30 SOT, 90 non-SOT matched controls), there were no differences in pre-operative demographics (age, BMI, ASA score, indications for procedure), surgical characteristics (blood loss, procedure time) or post-operative characteristics (anticoagulation regimen, antibiotic regimen, LOS, discharge disposition) between groups. No significant differences were found between groups in post-operative complications, 90-day ER visit, readmission, or DVT/PE, however the SOT group had a significantly higher frequency of nonunion or delayed union compared to controls (16.7% vs. 3.3%, p = 0.011). Sub-analysis showed kidney and heart transplant patients had significantly higher rates of closed pilon fractures (10.5% and 100% respectively, p = .006), and lung transplant patients had significantly higher rates of open bimalleolar fractures (66.7%, p< 0.001) compared to other transplant patients.
Conclusion:
Patients with history of SOT undergoing foot and ankle procedures after injury do not show a significant difference in overall complications, readmissions or ER visits after surgery compared to non-SOT patients. However, SOT did show an increased rate of delayed and non-union after surgery. The exact etiology of this difference is unknown, however close monitoring for union in SOT patients and perhaps a lower threshold for bone healing adjuvant therapies may be advantageous.