Surgical site infections after stabilization of pelvic ring injuries: a retrospective analysis of risk factors and a meta-analysis of similar studies

Abstract

Purpose Pelvic ring fractures requiring surgical stabilization are severe injuries. Surgical site infections occurring after stabilization of the pelvis are serious complications, requiring complex and multidisciplinary treatment. Methods This is a retrospective observational study from a level I trauma centre. One hundred and ninety-two patients who underwent stabilization of closed pelvic ring injuries without signs of pathological fracture were selected for inclusion into the study. After excluding seven patients for having incomplete data, the final study group consisted of 185 patients (117 men and 68 women). Basic epidemiologic data and potential risk factors were recorded and analyzed by Cox regression, Kaplan–Meier curves, and risk ratios in 2 × 2 tables. Categorical variables were compared by Fisher exact tests and chi squared tests. Parametric variables were analyzed with Kruskal–Wallis tests with post hoc Wilcoxon tests. Results Surgical site infections occurred in 13% of the study group (24 from 185). Eighteen infections occurred in men (15.4%) and six in women (8.8%). There were two significant risk factors in women: age over 50 years (p = 0.0232) and concomitant urogenital trauma (p = 0.0104). The common risk ratio for both these factors was 212.59 (8.78–5148.68), p = 0.0010. No significant risk factors were identified in men despite younger men having a higher incidence of infection (p = 0.1428). Conclusion Overall rate of infectious complications was higher than in the literature, but this might be caused by inclusion of all patients regardless of surgical strategy. Higher age in women and lower age in men were associated with higher infection rates. Concomitant urogenital trauma was a significant risk factor in women.

Analysis of risk factors, clinical outcomes, and medical costs for pelvic infection after open pelvic fractures: A seven-year retrospective observation study at a single trauma centre

“…Tsugawa et al reported that E. coli and Bacteroides are the main pathogens that cause infectious complications in OPFs [14]. Salášek et al, who reported on surgical site infections in patients with pelvic ring injuries, found that coagulase-negative Staphylococcus, E. faecalis, Pseudomonas aeruginosa, and E. coli were the major pathogens [19]. In this study, the frequency of identi cation of major wound pathogens of pelvic infection was in the following order: E. faecalis, coagulase-negative Staphylococcus, E. coli, and S. aureus.…”

“…Several researchers have reported that the presence of shock, advanced sepsis, intra-abdominal injury, and low Glasgow coma scale are risk factors for the occurrence and death from pelvic infections in OPFs [2,7,8,12]. Early faecal diversion, repeated irrigation and debridement, negative pressure wound therapy, external xation of the pelvis, and early multidisciplinary approaches have been reported as methods for treating pelvic infections caused by OPFs [6,8,10,11,[13][14][15][16][17][18][19]. Despite the development of these treatment strategies, OPFs are associated with high incidence of complications, long treatment periods, increased utilisation of medical resources, and high medical costs [3,5,8,10,11].…”