Association of Morbid Obesity (BMI ≥40) With Postoperative Complications and Pain After Insertional Achilles Tendinopathy Achilles Splitting Surgical Treatment.

BACKGROUND

Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain and is often managed surgically when conservative treatment fails. Wound complications are common after Achilles surgery. Obesity is a known risk factor for such complications; however, evidence on morbid obesity (body mass index [BMI] ≥ 40) and outcomes after IAT repair is limited. This study evaluates the incidence of complications and pain relief in patients undergoing IAT surgery by BMI group.

METHODS

This is a retrospective cohort study. All patients with an established diagnosis of IAT who underwent an Achilles central splitting, detachment, debridement, and reattachment surgery between 2015 and 2023 were included. Patient demographics, surgical outcomes, and reported pain (visual analog scale for pain [VAS] scores) were collected. Patients were categorized into 2 BMI groups: <40 and ≥40. Statistical analysis included independent t test, Fisher exact, and χ2 testing.

RESULTS

There were 123 patients in this study, of which 90 had BMI <40 and 33 had a BMI ≥40. The mean age was 53.6 ± 10.6 years. Twenty-four had documented complications: higher in the morbidly obese group (30.3%) than in non-morbidly obese patients (15.6%, P = .077), with a significantly increased rate of wound dehiscence (24.2% vs 8.9%, P = .035; relative risk 2.72, 95% CI 1.11-6.67). VAS scores were highest in patients with BMI ≥40 compared to BMI <40 both preoperatively (P = .003) and at their final follow-up appointment (P = .006). No difference was found in change in VAS scores from preoperative to final follow-up visits (P = .818).

CONCLUSION

Morbid obesity was associated with increased wound complications and higher levels of pain in this retrospective cohort undergoing IAT surgical repair. However, VAS reduction after surgery was comparable across BMI groups.

LEVEL OF EVIDENCE: Level III, retrospective cohort.