An Evaluation of Basic Demographic Characteristics in Foot and Ankle Surgery From the American College of Surgeons National Surgical Quality Improvement Program

Derivation and validation of a risk calculator for the prediction of incidence of complications following repair of Achilles Tendon Rupture

BACKGROUND

The Achilles tendon is the body's strongest and largest tendon. It is commonly injured, particularly among athletes, accounting for a significant portion of serious tendon injuries. Several factors play a precipitating role in increasing the risk of these injuries.

OBJECTIVE

Our objective is to derive and validate a risk calculator for the prediction of incidence of any complication following Achilles tendon repair.

METHODS

We used de-identified data from the American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) database from 2005 to 2021. It comprises 7010 individuals who had undergone Achilles tendon rupture repair. Demographic and risk factors information was collected. To develop the calculator, the sample was divided into a derivation cohort (40%) and a validation cohort (60%). Multivariate logistic regression was used for statistical analysis, and a risk calculator for incidence of any complication was derived from the derivation cohort and validated on the remaining 60% of the sample. Patients with missing data were excluded, and the significance level was set at p < 0.05.

RESULTS

We analyzed the derivation cohort of 2245 individuals who underwent Achilles tendon repair surgery between 2005 and 2021, with a 5.5% overall complication. Multivariate logistic regression identified anesthesia type, ASA classification, certain co-morbidities (pre-operative dialysis and medication-requiring hypertension), and wound classification as significant predictors of complications. The developed risk calculator model had an area under the curve (AUC) of 0.685 in the derivation cohort and 0.655 in the validation cohort, surpassing the widely used and validated modified frailty index. A cut-off score threshold of 0.06 was established using Youden's index to dichotomize individuals into low and high risk for developing any postoperative complications.

CONCLUSION

Our risk calculator includes factors that most significantly affect the incidence of any complication following Achilles tendon repair.

Special Considerations in Podiatric Science: Translational Research, Cadavers, Gait Analysis, Dermatology, and Databases

The objective of this article is to provide a brief overview of the critical analysis and design of unique and perhaps less common methodologies in podiatric science. These include basic science translational designs, cadaveric investigations, gait analyses, dermatologic studies, and database analysis. The relative advantages, disadvantages, and inherent limitations are reviewed with an intention to improve the interpretation of results and advance future foot and ankle scientific endeavors.

Achilles tendon rupture primary repair technique: A comparative retrospective study between graft versus no-graft

Introduction

Achilles tendon rupture is one of the most common musculoskeletal injuries and accounts to 20 % of all large tendon ruptures The surgical choice of a procedure might play a role in the incidence of postoperative complications. This study aimed to estimate and compare the incidence of complications occurring within a 30-day window following primary surgical repair of the Achilles tendon with or without a graft.

Methods

A retrospective cohort study was conducted using the ACS NSQIP database from 2005 to 2021. Patients were divided into 2 cohorts (primary surgical repair with and without graft).

Results

A total of 7010 patients were included in the analysis. Among the graft group, 10.9 % reported any complication which was double the percentage of complications in the no graft group. Only 3.8 % of the no graft patients had reported systemic complications compared to 8.3 % in the graft group. Chronic steroid use was found to be an effect modifier in the incidence of any complications after primary surgical repair when comparing graft versus no graft (P-value 0.016).

Conclusion

Surgical repairwith tendon graft develops more complications than repairing without graft. Therefore, it is imperative for physicians to strive for an early diagnosis, as any delay in treatment significantly raises the likelihood of complications.

Levels of evidence

III, Retrospective Cohort Study.