Infection following foot and ankle surgery: Further analysis of data captured from the UK FATE Audit

J Shepherd, L Mason, L Houchen-Wolloff, K Malhotra, J Mangwani

Background: The UK Foot and Ankle Thromboembolism (UK FATE) Collaborative’s primary aim was to evaluatein idence of venous thromboembolism (VTE), however it also recorded other complications, including infection rate within 90 days. (1) We therefore aimed to evaluate overall rate of superficial and deep infection following foot and ankle surgery; whether this differed between trauma, elective and acute diabetic surgery; and patient and operative factors affecting infection.

Methods: Data were collected prospectively across 68 centres UK-wide for all patients who underwent foot and ankle surgery, or treatment of Achilles tendon ruptures, between 1st June to 30th November 2022. Data collected included development of superficial and deep infection within 90 days of procedure and presence of co-morbidities.

Results: A total of 9,723 patients were available for analysis. Overall superficial and deep infection rates in trauma, elective and acute diabetic procedures were 4.14% (n=397/9591) and 1.39% (n=133/9591), respectively. Superficial infections were highest in acute diabetic procedures (7.44% (n=29/361)) compared to trauma (3.87% (n=171/4245)) and elective (4.12% (n=197/4588)). Observed deep infection differed between trauma (1.47% (n=65/4351)), elective (0.71% (n=34/4785)) and acute diabetic (8.72% (n=34/356)) procedures. On multi-regressions analysis ASA grade III-IV (p=.01, OR 1.89), current smoker (p<0.001, OR 2.46), diabetes (p<.001, OR 3.06), peripheral vascular disease (p<0001, OR 3.33) and taking chemical prophylaxis (p=0.028, OR 1.60) were independent predictors of infection.

Conclusions: The rate of superficial and deep infections were significantly higher in patients with acute diabetic foot surgery. Deep infection rates were higher in trauma than in elective surgery, but superficial infection rates were similar. Co-morbidities and smoking affect infection rate in foot and ankle surgery and should be considered both pre-operatively and in post-operative monitoring. This data represents infection within 90 days of procedure; however evaluation of long-term outcomes will provide further insight.