Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture Surgery

Ma, Tao; Lu, Kaosheng; Song, Lanying; Wang, Dongyue; Ning, Sheng‐Hua; Chen, Ziqi; Wu, Zhanyong

doi:10.1080/08941939.2018.1556364

Cited by 30 publications

(37 citation statements)

References 35 publications

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“…Surgery in elderly patients represents an at‐risk procedure in terms of both anaesthetic and surgical plan, and the ASA classification system was a practicable and excellent assessment tool for estimation of the inpatients' physical status and endurance capability to surgery and anaesthesia. The ASA score has been identified as an independent risk factor of postoperative SSI in orthopaedics and other disciplines . In the present study, the ASA classified III‐IV score was associated with quite a high risk of SSI (OR = 2.2).…”

Section: Discussionsupporting

confidence: 49%

“…It has been demonstrated that approximately half of the SSIs can be prevented by application of evidence‐based prevention strategies, of which the identification of sensitive risk factors is a cost‐effective method. Prognostic risk factors associated with postoperative SSI included operating time, body mass index (BMI), gender, diabetes mellitus, length of hospital stay, delay in surgery, and so on, and were confirmed in published studies. However, most of these predictors were unmodifiable, and there were no clear‐cut values for some continuous variables, such as operative duration, level of serum albumin (ALB), blood glucose (GLU), and intraoperative blood loss.…”

Section: Introductionmentioning

confidence: 79%

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Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Dong

Liang

et al. 2019

International Wound Journal

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Geriatric population is increasing rapidly worldwide, and fragility fracture and complication following orthopaedic surgery in elderly people have now become major challenges for surgeons. Further studies are required to identify potentially modifiable factors associated with surgical site infection (SSI) in geriatric patients. This retrospective, multicenter study was conducted at four level I hospitals in China. During the 31-month study period, a total of 2341 patients (65 years or older) underwent orthopaedic surgery and complete data were recorded from September 2015 to April 2018. Demographics information, medications and additional comorbidities, surgery-related variables, and laboratory indexes were extracted and analysed. Receiver-operating characteristic analysis was performed to detect the optimum threshold of continuous variables. Independent risk factors of SSI were identified by univariate and multivariate analyses. Finally, 63 patients suffered from wound infection within the follow-up period, indicating a 2.7% incidence rate of SSI. Statistical results showed that open injury (odds ratio [OR], 9.5; 95% confidence interval [CI], 5.4-16.7), American Society of Anesthesiologists classified III-IV score (OR, 2.2; 95% CI, 1.3-3.8), surgical duration of >132 minutes (OR, 2.9; 95% CI, 1.1-5.0), serum albumin (ALB) of <36.4 mg/L (OR, 2.0; 95% CI, 1.6-3.4), and blood glucose (GLU) of >118 mg/dL (OR, 3.1; 95% CI, 1.1-5.3) were independent risk factors of postoperative SSI. With the application of sensitive and modifiable variables such as surgical duration and the levels of ALB and GLU, more geriatric patients with sub-high risk of postoperative SSI could be identified.

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Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 79%

Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Dong

Liang

et al. 2019

International Wound Journal

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“…But due to the limited cases (17 cases), this association was not definitive and its mechanism requires to be further investigated. The role of preoperative stay in risk of SSI in elective foot and ankle surgery should be rationally treated because the causes might be multifactorial, such as more time needed for optimization of comorbidities, unavailability of operation resources, weekends, or holidays [30,31]. About 5% of patients in this study had an increased neutrophil count (> 6.3 × 10 9 /L), in whom the incidence rate of SSI was 7.8%, significantly higher than those with normal range of neutrophil count.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Meng

Zhu

et al. 2020

J Orthop Surg Res

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Background This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors. Methods This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI. Results A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12). Conclusions SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.

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“…However, the role of prolonged preoperative stay in development of DVT might be complex and should be treated dialectically. In fact, there were multiple factors that could affect the preoperative hospital stay, such as severity of trauma, number and severity extent of comorbidities or the availability of operation room [25]. Also, the prolonged preoperative stay meant the longer-duration immobilization of injured limb, which is a most common cause for DVT [26].…”

Section: Discussionmentioning

confidence: 99%

Incidence of deep venous thrombosis (DVT) of lower extremity in patients undergoing surgeries for ankle fractures

Luo¹,

Chen²,

Li³

et al. 2020

Preprint

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Objective To investigate the incidence of postoperative deep venous thrombosis (DVP) in patients undergoing surgeries for ankle fractures and identify the associated risk factors. Methods This was a retrospective study. A total of 1451 patients undergoing surgery of ankle fractures from January 2016 to June 2019 were included. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury and surgery-related data and laboratory biomarkers. DVT of lower extremity was diagnosed by routine doppler examination. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors.Results Among the 1451 patients, DVT was confirmed in 38 cases, indicating an incidence of 2.6%. DVT involved both the operated and non-operated limbs in 8 patients (21.1%). DVT involved superficial femoral vein in 4 cases (6.6%), deep femoral vein in 2 (3.3%), popliteal vein in 5 (8.2%), posterior tibial vein in 11 (18.0%) and peroneal vein in 39 (63.9%). The median interval between operation and diagnosis of DVT was7 days. Six risk factors were identified to be independently associated with DVT, including age (10-year increase) (OR, 1.44), preoperative stay (delay of each day) (OR, 1.11), anesthesia (general vs regional) (OR, 3.51), lower hemoglobin level (OR, 2.02), total cholesterol >5.2mmol/L (OR, 3.20) and reduced lymphocyte count (OR, 3.16). Conclusion These identified factors, although not easily modifiable, do help counsel patients about the risk of DVT and help individualized assessment of the risk factors and accordingly the risk stratification.

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Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture Surgery

Cited by 30 publications

References 35 publications

Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study

Incidence of deep venous thrombosis (DVT) of lower extremity in patients undergoing surgeries for ankle fractures

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