Risk Factors for Complications after Primary Repair of Achilles Tendon Ruptures

Background: Operative treatment of Achilles tendon ruptures is associated with lower rates of rereupture compared to nonoperative treatment. However, concerns regarding adverse events (AE) in the postoperative period such as wound complications and surgical site infection (SSI) persist. The purpose of this study was to identify patient characteristics associated with the occurrence of adverse events in Achilles tendon rupture (ATR) surgical repair cases. Methods: Primary ATR repairs completed from 2005-2012 were identified in the ACS-NSQIP database. Univariate analyses were conducted to identify patient characteristics associated with 30 day postoperative complications. A high risk (HR) cohort group of patients who were either obese (Body Mass Index [BMI]>30), had a history of diabetes, or a history of smoking were compared to healthy controls. A multivariate logistic regression analysis of the overall cohort was done to assess for independent predictors of AEs. Results: In total, 1,164 patients met inclusion criteria with 615 meeting criteria for the HR cohort (53%). Overall, 2% (n=23) of the group sustained an AE postoperatively and, the most common AE was superficial SSI (0.9%, n=10). Operative time was longer in HR group compared to other ATR cases in the study (57.95 ± 28.2 minutes vs. 63.16 ± 30.2 minutes, p=0.002). Multivariate analysis did not reveal any patient characteristics to be significantly associated with the occurrence of an adverse event or superficial SSI. Conclusions: Rates of AEs in the 30 day postoperative period for surgically repaired ATR are very low. Obesity, diabetes and a history of smoking do not seem to predispose patients to AEs following repair of an ATR.