Surgical site infections after distal radius fracture surgery: a nation-wide cohort study of 31,807 adult patients

Abstract

Background Surgical site infections (SSI) after distal radius fracture (DRF) surgery have not previously been studied as the primary outcome in a large population with comparative data for different surgical methods. The aims of this study were 1) to compare SSI rates between plate fixation, percutaneous pinning and external fixation, and 2) to study factors associated with SSI. Methods We performed a nation-wide cohort study linking data from the Swedish national patient register (NPR) with the Swedish prescribed drug register (SPDR). We included all patients ≥18 years with a registration of a surgically treated DRF in the NPR between 2006 and 2013. The primary outcome was a registration in the SPDR of a dispensed prescription of peroral Flucloxacillin and/or Clindamycin within the first 8 weeks following surgery, which was used as a proxy for an SSI. The SSI rates for the three main surgical methods were calculated. Logistic regression was used to study the association between surgical method and the primary outcome, adjusted for potential confounders including age, sex, fracture type (closed/open), and a dispensed prescription of Flucloxacillin and/or Clindamycin 0–8 weeks prior to DRF surgery. A classification tree analysis was performed to study which factors were associated with SSI. Results A total of 31,807 patients with a surgically treated DRF were included. The proportion of patients with an SSI was 5% (n = 1110/21,348) among patients treated with plate fixation, 12% (n = 754/6198) among patients treated with percutaneous pinning, and 28% (n = 1180/4261) among patients treated with external fixation. After adjustment for potential confounders, the surgical method most strongly associated with SSI was external fixation (aOR 6.9 (95% CI 6.2–7.5, p < 0.001)), followed by percutaneous pinning (aOR 2.7 (95% CI 2.4–3.0, p < 0.001)) (reference: plate fixation). The classification tree analysis showed that surgical method, fracture type (closed/open), age and sex were factors associated with SSI. Conclusions The SSI rate was highest after external fixation and lowest after plate fixation. The results may be useful for estimation of SSI burdens after DRF surgery on a population basis. For the physician, they may be useful for estimating the likelihood of SSI in individual patients.

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR): an international multicentre prospective cohort study

“…First, the provision of preoperative antibiotics (either as a short oral course in the days leading up to emergency surgery or as a one-off dose at the time of anaesthesia induction) was not associated with a reduced risk of SSI in either the elective or emergency surgery models. This is in keeping with the wider literature on perioperative antibiotic use in upper limb surgery 34 , 35 , 44 , 45 which demonstrates no benefit from (pre- or postoperative) antibiotics in patients who have no clinical features of infection and who are destined for surgery. As we approach an existential crisis surrounding antimicrobial resistance 25 , surgeons could consider exercising greater restraint and prescribe fewer antibiotics until definitive evidence from high-quality multicentre randomised trials is generated.…”

Prevalence of surgical wound infection and related factors in patients after long bone surgery: A systematic review and meta‐analysis

“…Twenty‐three studies were removed owing to improper research design or outcomes, and 22 studies were discarded due to a lack of necessary data after carefully examining the full text of 55 studies. Finally, this systematic review and meta‐analysis included 12 studies 8–10,19–27 …”

“…The prevalence of surgical wound infection in femur fracture was between 2% and 14% 8,9 . The prevalence rate of radius and leg (tibia and fibula) fractures was 9% and 14%, respectively 9,10 . The occurrence of this complication after orthopaedic surgeries is much more challenging because it is difficult to eliminate the bone and joint infection and the lifetime risk of recurrence is 10%–20% 11 …”

Incidence and risk factors for surgical site infection following volar locking plating (VLP) of unstable distal radius fracture (DRF)

“…Two large studies using national database reported the far lower incidence rates of SSI, the one was 0.9% within 180 days of fixation (1.3% for percutaneous and 0.8% for open fixation) in 87,169 DRF patients [ 17 ], and the other was 0.3% within 90 days in patients who underwent the open reduction and internal fixation for DRF [ 7 ]. In another nation-wide study of 31,807 adult patients undergoing plating of DRFs, incidence rate of SSI was 5% [ 9 ]. However, these studies did not separate the VLP procedure and even in Mahmood et al’ study SSIs resolved by oral antibiotics were not counted [ 7 ], thus likely not reflecting the true SSI rate after VLP.…”

“…In 2015, a meta-analysis of 7 randomized controlled trials comprising 875 patients undergoing VLP versus percutaneous pinning of displaced DRFs reported an incidence rate of SSI of 3.2% [ 6 ]. Similarly, regarding the risk factors for SSI, results were inconclusive and occasionally even conflicting, primarily due to the heterogeneous population, relatively small sample size, or inclusion of limited number of variables for adjustment [ 7 – 9 ]. However, to our best knowledge, none of these studies were specifically designed to address the SSI after VLP, and thus these results might be less applicable.…”