Risk factor of postoperative incision infection after plate internal fixation of calcaneal fractures: a retrospective study

Abstract

Background This study aimed to investigate the risk factors for incision infection after plate internal fixation for calcaneal fractures by a traditional lateral L-shaped approach. Methods The clinical data of 302 patients with calcaneal fractures who underwent surgical treatment in our hospital from January 2012 to June 2018 were retrospectively analysed, consisting of 177 males and 125 females. The enrolled patients were aged 21 to 75 years, with a mean age of 47.72 years. According to the Sanders classification, 108 patients were type II, 138 patients were type III, and 56 cases were type IV. A univariate analysis was conducted with sex, age, smoking history, history of diabetes, cause of injury, Sanders type, tension blisters, time from injury to surgery, preoperative haemoglobin, preoperative albumin, operation time, and bone grafting as possible risk factors. The factors with statistically significant differences were selected for multivariate binary logistic regression analysis. The clinical cut-off values of these risk factors were calculated using characteristic curves. Results The follow-up lasted for at least 1 year for all patients, with a mean follow-up time of 15.8 months. The results demonstrated 7.9% (24/302) infection rate after plate internal fixation of calcaneal fractures by the traditional lateral L-shaped approach. Univariate analysis showed that a history of diabetes, preoperative albumin, preoperative haemoglobin, time from injury to surgery, and operation time were correlated with incision infection (p < 0.05). Additionally, multivariate regression analysis indicated that a shorter time from injury to surgery (OR = 1.475, 95% CI: 1.024-2.125, p = 0.037), lower preoperative albumin (OR = 1.559, 95% CI: 1.191-2.041, p = 0.001), and longer operation time (OR = 1.511, 95% CI: 1.219-1.874, p < 0.001) were risk factors for postoperative incision infection, and their cut-off values were 10.5 days, 38.5 g/L, and 84.5 minutes, respectively. Conclusion Longer preoperative stay and operation time were two risk factors for postoperative incision infection. However, lower preoperative albumin level is the highest risk factor in this study. Trial registration The trial was registered in the China Clinical Trial Registry (ChiCTR2100047038).

Prevalence of surgical site infection and risk factors in patients after knee surgery: A systematic review and meta‐analysis

“…As shown in Figure 2, all included studies 18,26–33 were of high quality. Also, one study 27 did not report funding sources or conflicts of interest.…”

Prevalence of surgical site infection and risk factors in patients after foot and ankle surgery: A systematic review and meta‐analysis

“…As shown in Figure 2, all included studies 6,11,15–21 were of high quality. Also, one study 6 did not report funding sources or conflicts of interest.…”

The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery

“…Notably, in a study evaluating lower extremity fractures in patients younger than 65 years, ankle and pilon fractures were the second most common fracture type among the malnourished, frail, and malnourished plus frail cohorts (hip fractures ranked first) 13 . Hypoalbuminemia is reported to significantly increase the risk of SSI and hospital LOS in ankle ORIF, calcaneus ORIF, foot/ankle arthrodesis, and Achilles tendon repair in all except one study, which lost significance for SSI in ankle ORIF after multivariate analysis 5,24,159-161 . Kisana et al attempted to create a scoring system for predicting surgical complications in foot and ankle surgery in which hypoalbuminemia is the second highest scoring risk factor behind anemia, highlighting the importance of nutritional optimization in this field 162 .…”

“…The impact of nutrition in surgery is starting to become more recognized, with a recent body of literature demonstrating worse postoperative clinical outcomes in the malnourished across all orthopaedic subspecialties, as well as the potential for substantial improvement with appropriate supplementation and focus on perioperative optimization 1-15 . Malnutrition is commonly defined by a disorder of energy, protein, and nutrients (either a deficiency or excess, in the case of obesity) that has been associated with increased morbidity in orthopaedic surgery 16-20 .…”