Risk Factors for Postoperative Complications in Hallux Valgus Surgery: A Retrospective Cohort Study

Background/Objectives: Hallux valgus is a common forefoot deformity whose surgical correction generally yields favorable functional outcomes. However, postoperative complications remain a clinically relevant concern, and the contribution of preoperative risk factors has not been comprehensively characterized in the context of the Spanish population. This study aimed to analyze the relationship between preoperative risk factors and the occurrence of complications after hallux valgus surgery, and to assess whether their accumulation follows a dose-response pattern of increased postoperative risk. Methods: A retrospective observational study was conducted in 123 consecutive patients who underwent hallux valgus surgery between 1 January 2017 and 31 December 2018, with a mean follow-up of 12 months. Variables analyzed included age, sex, deformity severity, active smoking, diabetes mellitus, and antiplatelet or anticoagulant therapy. An accumulated risk factor index based on three clinical risk factors was constructed. Statistical analysis included descriptive statistics, the Cochran-Armitage trend test, and multivariate logistic regression. Results: The mean age was 57.4 years; 82.1% were female. Active smokers accounted for 31.7%, 14.6% had diabetes mellitus, and 13.0% were receiving antithrombotic therapy. The overall complication rate was 20.3%, comprising recurrence (12.2%), chronic residual pain (6.5%), joint stiffness (4.1%), and infection (4.1%). Complication frequency increased progressively from 15.9% in patients without risk factors to 50.0% in those with three concurrent factors (p-trend = 0.038). In multivariate analysis, male sex (odds ratio [OR] 5.39; 95% confidence interval [CI] 1.41-21.19; p = 0.014) and diabetes mellitus (OR 8.37; 95% CI 1.42-63.60; p = 0.026) were independently associated with a higher risk of complications. Conclusions: Hallux valgus surgery generally has a favorable prognosis; however, the presence of preoperative risk factors significantly influences postoperative risk. Diabetes mellitus and the accumulation of risk factors identify patients who could benefit from more rigorous preoperative evaluation, metabolic optimization, and closer postoperative follow-up.