TY - JOUR
T1 - Charcot Reconstruction
T2 - Outcomes in Patients With and Without Diabetes
AU - Cates, Nicole K.
AU - Wagler, Emily C.
AU - Bunka, Taylor J.
AU - Elmarsafi, Tammer
AU - Tefera, Eshetu
AU - Kim, Paul J.
AU - Liu, George T.
AU - Evans, Karen K.
AU - Steinberg, John S.
AU - Attinger, Christopher E.
N1 - Funding Information:
This study was supported by the Department of Plastic Surgery, MedStar Georgetown University Hospital. John S. Steinberg is the guarantor of the content of this manuscript. Nicole K. Cates, DPM; Emily C. Wagler, DPM; Taylor J. Bunka, DPM; Tammer X. Elmarsafi, DPM, MBBCh; Eshetu Tefera, MS; Paul J. Kim, DPM; Karen K. Evans, MD; John S. Steinberg DPM; Christopher E. Attinger, MD: have no financial disclosures, commercial associations, or any other conditions posing a conflict of interest to report.
Publisher Copyright:
© 2020 the American College of Foot and Ankle Surgeons
PY - 2020/11/1
Y1 - 2020/11/1
N2 - The objective of this study is to compare risk adjusted matched cohorts of Charcot neuroarthropathy patients who underwent osseous reconstruction with and without diabetes. The 2 groups were matched based on age, body mass index, hypertension, history of end-stage renal disease, and peripheral arterial disease. Bivariate analysis was performed for preoperative infection, location of Charcot breakdown, and post reconstruction outcomes, in patients with a minimum of 1 year follow-up period. Through bivariate analysis, presence of preoperative ulceration (p = .0499) was found to be statistically more likely in the patients with diabetes; whereas, delayed osseous union (p = .0050) and return to ambulation (p ≤ .0001) was statistically more likely in patients without diabetes. The nondiabetic Charcot patients were 17.6 folds more likely to return to ambulation (odds ratio [OR] 17.6 [95% confidence interval {CI} {3.5-87.6}]), and 16.4 folds more likely to have delayed union (OR 16.4 [95% CI {1.9-139.6)]). Subanalysis compared well-controlled diabetic and nondiabetic Charcot neuroarthropathy patients for same factors. Multivariate analysis, in the subanalysis, found return to ambulation was 15.1 times likely to occur in the nondiabetic CN cohort (OR 15.1 [95% CI 1.3-175.8]) compared to the well-controlled diabetic CN cohort.
AB - The objective of this study is to compare risk adjusted matched cohorts of Charcot neuroarthropathy patients who underwent osseous reconstruction with and without diabetes. The 2 groups were matched based on age, body mass index, hypertension, history of end-stage renal disease, and peripheral arterial disease. Bivariate analysis was performed for preoperative infection, location of Charcot breakdown, and post reconstruction outcomes, in patients with a minimum of 1 year follow-up period. Through bivariate analysis, presence of preoperative ulceration (p = .0499) was found to be statistically more likely in the patients with diabetes; whereas, delayed osseous union (p = .0050) and return to ambulation (p ≤ .0001) was statistically more likely in patients without diabetes. The nondiabetic Charcot patients were 17.6 folds more likely to return to ambulation (odds ratio [OR] 17.6 [95% confidence interval {CI} {3.5-87.6}]), and 16.4 folds more likely to have delayed union (OR 16.4 [95% CI {1.9-139.6)]). Subanalysis compared well-controlled diabetic and nondiabetic Charcot neuroarthropathy patients for same factors. Multivariate analysis, in the subanalysis, found return to ambulation was 15.1 times likely to occur in the nondiabetic CN cohort (OR 15.1 [95% CI 1.3-175.8]) compared to the well-controlled diabetic CN cohort.
KW - 3
KW - Charcot neuroarthropathy
KW - Retrospective Study
KW - delayed osseous union
KW - return to ambulation
KW - well controlled diabetic patients
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U2 - 10.1053/j.jfas.2020.05.019
DO - 10.1053/j.jfas.2020.05.019
M3 - Article
C2 - 32921562
AN - SCOPUS:85090590504
SN - 1067-2516
VL - 59
SP - 1229
EP - 1233
JO - Journal of Foot and Ankle Surgery
JF - Journal of Foot and Ankle Surgery
IS - 6
ER -