Risk of surgical site infection in hand trauma, and the impact of the SARS-CoV-2 pandemic: A cohort study

Abstract

Background : Despite the ubiquity of hand trauma, there remains insufficient published data to reliably inform these patients of surgical site infection (SSI) risk. We describe the risk of SSI in a single-centre cohort of hand trauma patients, with an analysis of the impact of the COVID-19 pandemic. Methods : Retrospective data collection of consecutive patients who underwent surgery for hand and wrist trauma in a single plastic surgery centre over two, three-month periods. Demographic, injury and operative details, alongside prophylactic antibiotic use, were recorded. Burn injuries and wounds infected at presentation were excluded. Presence of SSI at 30 days (90 days if a surgical implant was used) was assessed. Results : Overall, 556 patients - ‘Pre-COVID-19’ (n=310); ‘During COVID-19’ (n=246) - were included. Risk of SSI was 3.6% in the aggregated cohort. Female patients were more likely to develop an SSI, even when adjusted for their greater prevalence of bite aetiologies (adjOR 2.5; 95% CI, 1.00-6.37; p<0.05). The absolute risk of SSI in the ‘Pre-COVID-19’ group was 2.3% and 5.3% in the ‘During COVID-19’ group. The relative risk of developing an SSI in the ‘During COVID-19’ group, was 2.34 (95% CI, 0.95-5.78; p=0.06). Baseline characteristics were equivalent between the two groups. Conclusion : The risk of SSI in hand trauma is the same as the nationally estimated risk for all surgery; 3-5%. Changes in presentation and practice associated with the first wave of the COVID-19 pandemic did not appear to alter the risk of SSI in patients undergoing surgery for hand trauma.

Asymptomatic or mildly symptomatic COVID-19 patients with craniomaxillofacial injuries have an increased risk of surgical site infection

“…Our recently published meta-narrative review 14 and prospective study 1 highlighted that not only the airway and oral cavity but ocular surfaces (which could be infected via the nasolacrimal duct) are VROs, and could host high viral density causing local microvascular pathology and poor wound healing. CMFI involving VROs are therefore a prominent risk factor for SSIs, which are significantly higher than surgery without VRO-contact, such as hand surgery 3 , caesarean births 4 , or appendectomy 5 (49/257 [19.1%] vs. 20/556 [3.6%] vs. 1/43 [2.3%] vs. 4/58 [6.9%]; P < 0.00001). Minimally invasive techniques could be an alternative for surgery involving VROs to reduce the surgical access size and viral splattering [1] , [14] , e.g.…”

“… 2 Our recent study, nevertheless, demonstrated the absence of nosocomial SARS-CoV-2 infection among hospital personnel in contact with asymptomatic COVID-19 patients undergoing midfacial fracture repair 1 , suggesting that craniomaxillofacial injury (CMFI) care in asymptomatic or mildly symptomatic COVID-19 patients (AS/MS-COVID) could be safe. Moreover, several studies rejected the association between SARS-CoV-2 infection and surgical site infections (SSI) such as after hand surgery 3 , caesarean births 4 , or appendectomy 5 .…”

Complication and Infection Risk Using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients– An Observational Study

“…The fracture gap was controlled regarding the bridging process. A visible edge was seen in fractures without consolidation (6). A reduction in density and a more impressive fracture gap (5) are followed by a blurred fracture line (4), a partially blurred and partially compressed fracture gap (3), and a compression of the fracture gap (2).…”

“…Next to prolonged hospital stays, a higher risk for inpatient mortality is reported [5]. In surgical treatment, any foreign material can increase the risk of infection [6]. Surgical side infection in trauma surgery is reported with a mean of 1%-2%.…”

Complication and Infection Risk using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients– An Observational Study

“…In surgical treatment, any foreign material can increase the risk of infection [6]. Surgical side infection in trauma surgery is reported with a mean of 1%-2%.…”