Determination of risk factors associated with surgical site infection in patients undergoing preperitoneal pelvic packing for unstable pelvic fracture

Abstract

Background: Several recent studies have shown that preperitoneal pelvic packing (PPP) effectively produces hemostasis in patients with unstable pelvic fractures. However, few studies have examined the rate of surgical site infections (SSIs) in patients undergoing PPP following an unstable pelvic fracture. The purpose of the present study was to evaluate factors associated with SSI in such patients.Methods: We retrospectively reviewed the medical charts of 188 patients who developed hemorrhagic shock due to pelvic fracture between April 2012 and May 2021. Forty-four patients were enrolled in this study.Results: SSI occurred in 15 of 44 patients (34.1%). The SSIs occurred more frequently in cases of repacking during the second-look surgery (0 vs. 4 [26.7%], P=0.010) and combined bladder-urethra injury (1 [3.4%] vs. 4 [26.7%], P=0.039). The incidence of SSIs was not significantly different between patients undergoing depacking within or after 48 hours (12 [41.4%] vs. 5 [33.3%], P=0.603). The mean time to diagnosis of SSI was 8.1±3.9 days from PPP. The most isolated organism was Staphylococcus epidermidis.Conclusions: Repacking and combined bladder-urethra injury are potential risk factors for SSI in patients with unstable pelvic fracture. Close observation is recommended for up to 8 days in patients with these risk factors. Further, 48 hours after PPP, removing the packed gauze on cessation of bleeding and not performing repacking can help prevent SSI. Additional analyses are necessary with a larger number of patients with the potential risk factors identified in this study.

Open Fixation After Preperitoneal Pelvic Packing Is Associated With a High Surgical Site Infection Rate

“…Pelvic space infections after PPP have been reported by other institutions to range from 10% to 34%. 8–10 Kim et al 9 reported a deep infection rate of 34% (15/44), which is similar to the infection rate observed in this study. They reported that infection was more common with repacking and bladder injuries, but they did not evaluate for an association with anterior ORIF.…”

“…These conflicting findings may be attributed to the fact that prior studies had insufficient follow-up time resulting in underreporting of the deep SSI rate. 3,7–10 The median follow-up time in the PPP group in this study was 13.1 months (IQR 8.1 to 36.3). By contrast, Li et al 8 reported an SSI rate of 10.3% (3/29) after PPP and had no reported minimum follow-up.…”

“…3,6 The rate of pelvic space surgical site infection (SSI) after PPP varies in the literature, ranging from 8% to 34%, with most studies not reporting a minimum follow-up time. [7][8][9][10] The advent of advanced resuscitation strategies, such as point of care-guided massive transfusion protocols and resuscitative endovascular balloon occlusion of the aorta (REBOA), may allow for liberalization of the threshold for PPP, thereby mitigating this serious morbidity. The purpose of this study was to determine the pelvic space SSI rate in operative pelvic fractures managed with and without PPP in patients with a minimum of 90 days of follow-up.…”

Angioembolization Has Similar Efficacy and Lower Total Charges than Preperitoneal Pelvic Packing in Patients with Pelvic Ring or Acetabulum Fractures

“…Still, it is also worth noting that PPP is generally a faster procedure than AE, so the intervention is likely completed sooner even if time to procedure is the same 25,26 ; however, PPP does have the increased morbidity of a larger incision and reoperation for packing removal. While relatively rare, deep infections following packing have been reported, 28 and Kim et al 29 reported surgical site infections in 34.1% of patients.…”