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Wound Healing Complications in Diabetics Undergoing Carpal Tunnel and Trigger finger release: A retrospective cohort study
Benjamin K Gundlach, MD1, Jeffrey N. Lawton, MD2 and John R. Lien, MD2, (1)University of Michigan, Ann Arbor, MI, (2)Orthopaedic Surgery, University of Michigan, Ann Arbor, MI

HYPOTHESIS
Compared to non-diabetic controls, patients with diabetes mellitus will have an increased association with wound healing complications after undergoing either trigger finger (TFR), or carpal tunnel release (CTR). Secondarily, diabetic patients with higher peri-operative hemoglobin A1C values will have an increased association with wound healing complications.

METHODS
•Experimental and control patients were retrospectively collected, consecutively, in an approximately 1:1 ratio based upon procedure from our hospital database between 2014-2018.
•Inclusion criteria: Underwent open CTR and/or TFR. For the experimental group, a preexisting diagnosis of Diabetes Mellitus (DM) with an A1C drawn within 90 days of surgery.
•Exclusion criteria: Concurrent bony/fracture work, systemic immunosuppression/chemotherapy, active malignancy, hypothyroidism, or autoimmune disorder.
•Wound healing complications were defined as either surgical site infection (SSI), wound dehiscence, and/or delayed wound healing.
•Chi-square testing was used to compare control vs experimental groups with wound healing complications and univariate logistic regression to examine predictive effect of covariates on wound complications
•Sub-analysis of diabetic peri-operative A1C collected within 90 days of surgery and any associated wound healing complications was performed using a logistic regression model.

RESULTS
•There were 259 non-diabetic, and 262 diabetic patients. Both groups underwent 336 procedures, making a combined 672 procedures.
•36 complications in the experimental group (23 infections requiring antibiotics), 9 in the control group (4 infections requiring antibiotics). All patients diagnosed with an SSI improved with an outpatient course of antibiotics.
•There was a significant difference in associated wound complications comparing diabetics and controls with Chi-Square testing X^2 =17.536, P <.001. Further univariate analysis demonstrated an odds ratio of 4.388 (95% CI 2.08 - 9.26).
•Among diabetics, univariate regression resulted in an odds ratio of 2.55 (P=0.043, 95% CI 1.03 - 6.33) at an A1C above 6.5.
•Univariate analysis revealed non-significant association in both the whole, and diabetic only, population (p=0.29, 0.159) with regard to smoking.

SUMMARY
•There was a significant higher rate of associated wound healing complications in diabetics undergoing CTR/TFR when compared to nondiabetics.
•Among diabetics, a HgA1C greater than 6.5 had an increased association with wound healing complications when compared to those below 6.5.


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