Increased Rate of Complications Following Trigger Finger Release in Diabetic Patients
Andrew E. Federer, MD; Rita E. Baumgartner, MD; Daniel Cunningham, MD, MHSc; Marc Richard, MD; Suhail K. Mithani, MD
Duke University Medical Center, Durham, NC
Introduction: An increased rate of complications has been demonstrated in patients with diabetes for a variety of orthopaedic procedures, such as in arthroplasty and spine surgery. Current data regarding the impact of diabetes mellitus (DM) on complications after open trigger finger release (TFR) is conflicting. We investigated postoperative complications following TFR in patients with and without DM.
Materials & Methods: A matched, case-control study was performed on all patients with DM that underwent TFR at a single academic institution within the past 10 years. Exclusion criteria were comorbid rheumatoid arthritis, malignancy, HIV/AIDS, connective tissue disorders, or systemic steroid use. One hundred forty-six diabetic patients were eligible for inclusion. These patients were then matched one-to-one to non-diabetic patients undergoing TFR based on age, sex, race, and BMI (normal, overweight, and grades 1-3 of obesity) during the same time period. Nine of 146 diabetic patients (6.2%) were unable to be matched due to their particular combination of BMI and race and were excluded. The remaining 137 patients (93.8%) were matched. The primary outcome measure was complications. Complications included superficial or deep infection, delayed wound healing, limited range of motion (ROM) at 6 weeks, pain requiring medication at 6 weeks, and return to operating room. Odds ratios with 95% confidence intervals (CI) were calculated to quantify the association of diabetes status with all-cause and specific complications.
Results: Diabetic patients had a significantly higher rate (45 / 137, 32.8%) of complications following TFR compared to matched non-diabetic controls (27 / 137, 19.7%) (Odds ratio of 2.0, 95% CI 1.2 - 3.5, p=0.013). Diabetic patients also had a significantly higher rate of limitation in post-operative ROM (36 / 137, 26.3%) compared to matched non-diabetic controls (12 / 137, 8.8%) (Odds ratio of 3.7, 95% CI 1.8 - 7.5, p<0.001). Rates of superficial infection (p=0.07), deep infection (p=0.58), delayed wound healing (p=0.14), pain requiring medication at 6 weeks (p=0.18), or return to the OR (p=0.24) were not significantly different between diabetic and non-diabetic patients. Incidence and nature of complications were not associated with preoperative Hemoglobin A1C level.
Conclusion: This retrospective case-control study indicates diabetic patients undergoing TFR are at increased risk for post-operative complications and ROM limitation when compared with similar patients without diabetes, regardless of blood sugar control. These are important considerations that inform preoperative patient counseling.
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