Infection rates after open tibial fractures: Are they decreasing?

Ktistakis, Ioannis; Giannoudi, Marilena; Giannoudis, Peter V.

doi:10.1016/j.injury.2014.03.022

Cited by 67 publications

(40 citation statements)

References 24 publications

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“…25 Over the past decades, surgical site infection incidence has decreased, especially deep infections in patients with open tibial fractures. 26 The question remained whether these rates could be decreased further. Still, no infections occurred in two studies in complex tibial fracture patients treated with antibiotic coated intramedullary tibia nails.…”

Section: Discussionmentioning

confidence: 99%

The economic burden of infections following intramedullary nailing for a tibial shaft fracture in England

Galvain

Chitnis

Paparouni³

et al. 2020

BMJ Open

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ObjectivesDetermine the impact of infections on direct costs and healthcare resource use in England for patients undergoing intramedullary nailing (IMN) for tibial shaft fractures.DesignNon-concurrent cohort based on retrospectively collected data with 2-year follow-up.SettingEngland.ParticipantsThe study population included adult patients (≥18 years) in England with a diagnosis of tibial shaft fracture (International Classification of Diseases-10, S822) in the inpatient setting between May 2003 and June 2017 followed by a procedure for IMN for tibial shaft fracture within 30 days. Patient data were derived from the Clinical Practice Research Datalink linked to National Health Service Hospital Episode Statistics datasets.Primary independent variableInfection.Primary and secondary outcome measuresThe primary outcome was total inpatient costs from index stay admission through 1 year of follow-up. Secondary outcome included cumulative total healthcare costs, and resource utilisation at 30 days, 90 days, 1 year and 2 years.ResultsOverall, 805 patients met the inclusion criteria. At index inpatient stay, 3.7% had a post-IMN infection, rising to 11.7% at 1 year. One-year inpatient costs were 80% higher for patients with infection (p<0.001). Total costs were estimated to be £14 756 (95% CI £13 123 to £16 593) for patients with infection versus £8279 (95% CI £7946 to £8626). Length of stay (LOS), readmission and reoperation were the key drivers of healthcare costs (all p<0.001). After adjustment, LOS was higher by 109% (95% CI 62% to 169%), from 10.5 days to 21.9 days, for patients with infection. The odds of being readmitted or requiring reoperation were higher by 5.18 times (95% CI 3.01 to 9.13) and 2.47 times (95% CI 1.48 to 4.09), respectively, for patients with infection versus those without infection.ConclusionsPost-IMN infection significantly increases inpatient costs, LOS, readmissions and reoperations associated with tibial fracture fixation. Healthcare burden could be reduced through novel surgical site infection prevention strategies.

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Section: Discussionmentioning

confidence: 99%

The economic burden of infections following intramedullary nailing for a tibial shaft fracture in England

Galvain

Chitnis

Paparouni³

et al. 2020

BMJ Open

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“…Over the past decades, it appears that there has been a steady reduction in the overall incidence of infection [7]. However, the question must be asked as to whether or not we have reached a plateau on what can be achieved by current protocols [8]. The persistence of the problem, and the somewhat unsatisfactory treatment outcomes, suggests that neither prophylaxis nor treatment of IFF is completely effective despite best practice, and further improvements should be sought.…”

Section: Introductionmentioning

confidence: 99%

Infection after fracture fixation: Current surgical and microbiological concepts

Metsemakers

Kuehl

Moriarty

et al. 2018

Injury

406

368

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One of the most challenging complications in trauma surgery is infection after fracture fixation (IAFF). IAFF may result in permanent functional loss or even amputation of the affected limb in patients who may otherwise be expected to achieve complete, uneventful healing. Over the past decades, the problem of implant related bone infections has garnered increasing attention both in the clinical as well as preclinical arenas; however this has primarily been focused upon prosthetic joint infection (PJI), rather than on IAFF. Although IAFF shares many similarities with PJI, there are numerous critical differences in many facets including prevention, diagnosis and treatment. Admittedly, extrapolating data from PJI research to IAFF has been of value to the trauma surgeon, but we should also be aware of the unique challenges posed by IAFF that may not be accounted for in the PJI literature. This review summarizes the clinical approaches towards the diagnosis and treatment of IAFF with an emphasis on the unique aspects of fracture care that distinguish IAFF from PJI. Finally, recent developments in anti-infective technologies that may be particularly suitable or applicable for trauma patients in the future will be briefly discussed.

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“…The development of infectious complications after open fractures is an often encountered problem, with a rate ranging from <1% in grade I open fractures to 30% in grade III fractures [1][2][3]. Infections can be classified as acute, which includes superficial and deep soft tissue infections, and chronic infections, which are almost always bone infections, i.e., osteomyelitis [4].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for infectious complications after open fractures; a systematic review and meta-analysis

Kortram

Bezstarosti

Metsemakers

et al. 2017

International Orthopaedics (SICOT)

113

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Infection rates after open tibial fractures: Are they decreasing?

Cited by 67 publications

References 24 publications

The economic burden of infections following intramedullary nailing for a tibial shaft fracture in England

The economic burden of infections following intramedullary nailing for a tibial shaft fracture in England

Infection after fracture fixation: Current surgical and microbiological concepts

Risk factors for infectious complications after open fractures; a systematic review and meta-analysis

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