Longer operative time is the risk for delayed wound healing after forefoot surgery in patients with rheumatoid arthritis

Abstract

Objectives. Forefoot deformities are common in patients with rheumatoid arthritis (RA) and often require operative treatment. There is a high rate of delayed wound healing after foot surgery, especially among patients with RA. The aim of this study was to identify risk factors of delayed wound healing in RA patients who had undergone forefoot surgery.

Methods. This study was a retrospective observational study designed to analyze the outcomes of all consecutive RA patients who had undergone toe arthroplasty from April 2010 through May 2014 at a single institute. Putative risk factors for delayed wound healing were assessed using univariate logistic regression analysis. Variables with α = 0.1 were then subjected to stepwise multivariate logistic regression analysis.

Results. A total of 192 RA patients (192 feet) were included in this study. Delayed wound healing was seen in 40 feet (40/192 [20.8%]). A stepwise multivariate logistic regression analysis revealed that longer operative time was the risk factor associated with delayed wound healing in RA patients undergoing forefoot surgery (p = 0.028, odds ratio = 1.19 [per 10 min], 95% confidence interval [CI]: 1.07–1.32).

Conclusions. This finding emphasizes the importance of preventing operative complications during forefoot surgery.

Keywords:

• Delayed wound healing
• Forefoot surgery
• Operative time
• Rheumatoid arthritis

Acknowledgments

We appreciate the members of Institute of Rheumatology, Tokyo Women's Medical University for their effort on IORRA cohort study.

Conflict of interest

K. Y. received honorarium for the lecture from Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Santen Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd. K. I. received honorarium for the lecture and/or unrestricted research grants from AbbVie, Inc., Asahi Kasei Pharma Corp., Astellas Pharma Inc., Bristol-Myers Squibb Co., Chugai Pharmaceutical Co., Eisai Co., Ltd., Hisamitsu Pharmaceutical Co. Inc., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co., Santen Pharmaceutical Co., Ltd., Taisho Toyama Pharmaceutical Co. Ltd., and Takeda Pharmaceutical Co., Ltd. H. Y. received honorarium for the lecture or consultancy from AbbVie, Inc., Astellas Pharma Inc., Bristol-Myers Squibb Co., Chugai Pharmaceutical Co., Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co. Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Ltd., and UCB Japan Co. Ltd. A. T. received honorarium for the lecture and/or unrestricted research grants from AbbVie, Inc., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., and Teijin Pharma Ltd. S. M. received honorarium for the lecture and/or unrestricted research grants from AbbVie, Inc., Asahi Kasei Pharma Corp., Bristol-Myers Squibb Co., Chugai Pharmaceutical Co., Daiichi Sankyo Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma Co., Nakashima Medical Co. Ltd., Santen Pharmaceutical Co. Ltd., Taisho Toyama Pharmaceutical Co. Ltd., and Takeda Pharmaceutical Co. Ltd. The sponsors were not involved in the study design; collection, analysis, and interpretation of data; writing of the paper; and/or decision to submit for publication. For the remaining author, no conflict of interest is declared.