New Research Confirms Diabetics at High Risk of Surgical Infection

I'll never forget the day that Mrs. Williamson looked me in the eye, waving her finger and said, "I want you to promise me that you won't cut off any of Warren's toes."

Warren Williamson was the father of my sister's best friend when I was growing up. And he was a diabetic who had developed neuropathy (numbness in the feet from diabetes). He had a "spot" on his foot he was concerned about and wanted me to make a housecall to check his feet. But Mrs. Warren was fearful. An uncle of hers had died after a toe infection led to an amputation. All she new about that episode was that her uncle was diabetic, he got a minor toe infection, then he needed a toe amputation and now he is dead.

As a longtime friend, and a diabetic foot surgeon, I was taken aback by her fear. So I looked her in the I and said, "I promise I will do everything in power to make sure you husband leaves this world with all of his toes." I could see the relief, as her expression changed.

As it turns out I kept my promise. But unfortunately Warren did ultimately die of a post-operative infection. Only it was after back surgery. The growing population of diabetic patients is leading to more and more surgical infections.

This month a new study was published in the Journal of Bone and Joint Surgery which shows that diabetic patients are significantly more at risk for surgical infections than non-diabetic patients. The article is entitled "Postoperative Infection Rates in Foot and Ankle Surgery: A Comparison of Patients with and without Diabetes Mellitus."

The researches set out to determine whether or not patients with diabetes are really at increased risk for infection following foot and ankle surgery, or not. To find out they reviewed the charts of 1000 patients who had orthopaedic foot and ankle surgery. The recorded whether or not any of those foot surgery patients had a diagnosis of diabetes mellitus, if they had a postoperative foot infection and information about the severity of infection. They also recorded whether the surgery was inpatient surgery or outpatient surgery, whether or not they used of internal fixation (like screws or plates to hold the bones together) or external fixation (like rods attached on the outside of the foot or ankle), history of tobacco use, history of organ transplantation, history of rheumatoid arthritis, the total length of surgery, follow-up time in weeks, and other medical conditions that might contribute to the foot surgery infection.

What they discovered was that 52% of all foot and ankle infections occurred in diabetics. But diabetics accounted for only 19% of all patients who had foot surgery or ankle surgery. They found that of those patients having foot and ankle surgery, those that had diabetes were about 4 times more likely to develop a post-operative infection following foot or ankle surgery.

Even worse, we know that diabetics get more severe infections. The study confirmed this and showed that diabetic patients were 5 times more likely to develop the sort of severe infection that might lead to prolonged hospitalization, a foot amputation or death from the infection.

Interestingly, there was no real difference in foot infection rates between those without diabetes and someone with uncomplicated diabetes (a mild case of diabetes). However, those with complicated diabetes (a bad case of diabetes) did have much higher rates of surgical foot infections than those with uncomplicated diabetes (a mild case of diabetes).

So, if you or someone you love has diabetes and is going to have foot surgery, make sure the surgeon understands all of the implications is taking precautions to prevent the infection. Ask questions. Ask whether or not the patient will get antibiotics at the beginning of the surgery. Ask in the surgeon covers the toes with ioban. Ask the surgeon for a scrub brush with surgical soap to scrub the foot the night before surgery. Ask the surgeon how often his diabetic foot surgery cases go bad.

It is your foot and you have the right to know. If your diabetic foot surgeon thinks he or she doesn't need to take the time to answer all of your questions, find another surgeon.

Dr. Christopher Segler is a podiatrist and award-winning podiatrist who practice in the San Francisco Bay Area. He provides House Calls for diabetic foot exams, diabetic foot emergencies, and diabetic foot wound treatment. Serving San Francisco, Marin, Palo Alto, and Walnut Creek. You can learn more about house calls in San Francisco as a solution to foot problems at www.DocOnTheRun.com and www.AnkleCenter.com.