Wound Complications in Thyroxine-Supplemented Patients Following Foot and Ankle Surgery

Background: Our hypothesis was that thyroxine supplementation in patients undergoing foot and ankle surgery would be associated with increased postoperative wound complications and wound dehiscence compared to patients without thyroxine supplementation. Materials and Methods: A retrospective review of 48 patients supplemented with thyroxine that underwent foot and ankle surgery was conducted and analyzed for wound complications. All patients were non-diabetic. A total of 94 historical controls were used to compare the incidence of wound complications to the thyroxine sample. Patient demographics, medical comorbidities, principal diagnosis and procedure performed were recorded. The presence or absence of wound dehiscence, infection or other wound complications was recorded for all patients based on the followup clinical notes in the electronic record. Results: In the thyroxine group, the most common diagnosis was degenerative arthritis (31%, n = 15), which also occurred in 28.7% of control patients (n = 27). Wound dehiscence was reported in 36.2% (n = 17) of thyroxine-supplemented patients compared to 10.8% of control patients (n = 10). After adjusting for age, gender, hypertension diagnosis, and vascular disease diagnosis, the odds for wound dehiscence remained significantly greater for the thyroxine group compared to control patients (adjusted OR = 3.7; 95% CI: (1.3, 11.4); p = 0.01). Conclusion: Overall, our results suggest increased wound dehiscence complications in the postoperative period for thyroxine-supplemented patients compared to control patients. This finding remained even after adjusting for the associated cardiovascular comorbidities seen in thyroxine-supplemented patients.

Level of Evidence: IV, Retrospective Case Series