Surgical site infection following operative treatment of open fracture: Incidence and prognostic risk factors

Abstract

Considering the high incidence of postoperative complications of open fracture, management of this injury is an intractable challenge for orthopaedist, and surgical site infection (SSI) is the devastate one. Screening for high‐risk patients and target them with appropriate interventions is important in clinical practice. The aim of this study was to identify modifiable factors that were associated with SSI following operative treatment of open fractures. This retrospective, multicentre study was conducted at three hospitals. A total of 2692 patients with complete data were recruited between June 2015 and July 2018. Demographic characteristics, operation relative variables, additional comorbidities, and biochemical indexes were extracted and analysed. Receiver operating characteristic analysis was performed to detect the optimum cut‐off value for some variables. Univariate and multivariate logistic analysis models were performed, respectively, to identify the independent risk factors of SSI. The overall incidence of SSI was 18.6%, with 17.0% and 1.6% for superficial and deep infection, respectively. Results of univariate and multivariate analyses showed the following: fracture type, surgical duration > 122 minutes, anaesthesia time > 130 minutes, intraoperative body temperature < 36.4°C, blood glucose (GLU) > 100 mg/dL, blood platelet (PLT) < 288 × 109, and white blood cells (WBC) > 9.4 × 109 were independent risk factors of postoperative wound infection following operative treatment of open fractures. Six modifiable factors such as surgical duration > 122 minutes, anaesthesia time > 130 minutes, intraoperative body temperature < 36.4°C, GLU > 100 mg/dL, PLT < 288 × 109, and WBC > 9.4 × 109 play an important role in the prevention of SSI, and these factors should be optimized perioperatively.

Correlation between surgical site infection and time-dependent blood platelet count in immunocompromised patients after femoral neck fracture

“…The results of univariate and multivariate analyses performed by Hu et al. 24 showed that the fracture type, operative duration of >122 minutes, anesthesia time of >130 minutes, intraoperative body temperature of <36.4°C, GLU concentration of >100 mg/dL, PLT count of <288 × 10 9 , and WBC count of >9.4 × 10 9 were independent risk factors for wound infection after surgical treatment of open fractures. In vitro experiments have shown that PLT interactions enhance the phagocytic capacity of neutrophils against various bacteria.…”

Open tibial fractures: An overview

“…77 A retrospective, multicentre study of 2692 patients with open fractures has reported a 18.6% overall incidence of surgical site infection, with 1.6% being deep infection. 121 Furthermore, they identified several risk factors associated with wound infection, including fracture type, increased operative duration (>122 min), increased anaesthesia time (>130 min), reduced intra-operative body temperature (<36.4 C), high blood glucose (>100 mg/dL), low blood platelets (<288 Â 10 9 ), and high white blood cells (9.4 Â 10 9 ). 121 There are no universal definitions for superficial and deep infection following open fracture injuries, however, these can be adjusted from the Centre's for Disease Control original definitions for surgical site infections.…”

“…121 Furthermore, they identified several risk factors associated with wound infection, including fracture type, increased operative duration (>122 min), increased anaesthesia time (>130 min), reduced intra-operative body temperature (<36.4 C), high blood glucose (>100 mg/dL), low blood platelets (<288 Â 10 9 ), and high white blood cells (9.4 Â 10 9 ). 121 There are no universal definitions for superficial and deep infection following open fracture injuries, however, these can be adjusted from the Centre's for Disease Control original definitions for surgical site infections. 122 A superficial infection can be defined as any infection which involves the skin and subcutaneous tissue (Fig.…”

Incidence and Risk Factors for Surgical Site Infection after Femoral Neck Fracture Surgery: An Observational Cohort Study of 2218 Patients

“…Published studies had confirmed that age, body mass index (BMI), greater index of comorbidities, hypoalbuminemia, surgical duration, increased duration of anesthesia, current smoking, and elevated fasting blood glucose level were the risk factors of SSI for hip fracture patients [ 9 – 12 ]. However, most previous studies focused on hip fractures, while only a few studies focused on femoral neck fractures separately.…”