Type of bone graft and primary diagnosis were associated with nosocomial surgical site infection after high tibial osteotomy: analysis of a national database

Abstract

Purpose Although several small-scale studies have reported risk factors for surgical site infection (SSI) after high tibial osteotomy (HTO), no study has collectively analysed risk factors in a large cohort. The present study aimed to clarify the risk factors for SSI after HTO using a national database. Methods Data of inpatients who underwent HTO from 2010 to 2017 were obtained from the Diagnosis Procedure Combination database in Japan. Outcome measures were the incidence of SSI and deep SSI after HTO. Associations between SSI and patient data were examined with multivariable logistic regression analysis. Results Among 12,853 patients who underwent HTO, 195 developed SSI (1.52%) and 50 developed deep SSI (0.39%). Univariate analysis showed that male sex, smoking, and longer anaesthesia duration were associated with higher incidences of SSI, whereas a primary diagnosis of osteonecrosis and use of natural bone grafts were associated with lower incidences. In multivariable analysis, SSI was positively associated with male sex, anaesthesia duration longer than 210 min (vs. 150-210 min), and use of artiicial bone graft (vs. natural bone graft). SSI was negatively associated with age ≤ 49 years (vs. 50-59 years) and a primary diagnosis of osteonecrosis (vs. osteoarthritis). ConclusionThe present study revealed novel risk factors for SSI after HTO that previous studies have failed to ind, including use of artiicial bone graft and longer anaesthesia duration; primary diagnosis of osteonecrosis and younger age were novel protective factors. These indings will help surgeons assess risks of SSI after HTO in individual patients. Level of evidence III.

Risk Factor Analysis for Infection after Medial Open Wedge High Tibial Osteotomy

“…In a systematic review that included 26 studies (level II: 1, level III: 5, and level IV: 20) and a total of 2026 patients, performed by Anagnostakos et al [11] in 2013, the incidence of superficial SSI was estimated to be 1-9% and that of deep SSI to be 0.5-4.7%. However, in the national database study by Kawata et al, the incidence of SSI was 1.52% and that of deep SSI was 0.39% [12]. Our number was closer to that described by Anagnostakos, but ours was much higher than the number in the latter article.…”

“…Deep SSI only developed in patients in whom artificial bone grafts were used. This finding was supported by the national database analysis by Kawata et al [12]. Multivariable analysis in their study showed SSI to be positively associated with the use of artificial bone grafts versus natural bone grafts.…”

Postoperative Infection: Prevention, Diagnosis, and Treatment Guidelines for the Sports Surgeon

“…13 In contradistinction, a more recent study reported males, longer anesthesia time ( > 210 min), and use of artificial bone graft to be associated with increased infection risk. 14 That stated, infection rates following osteotomies are typically low, with reported rates of 1.6% superficial infections and 0.7% deep infections. 15 In anterior cruciate ligament (ACL) surgery, despite very low overall infection rates, studies have reported an increased risk of infection with allograft and hamstring autograft as compared with bone-patellar tendon-bone autograft.…”

Chinese Clinical Practice Guidelines in Treating Knee Osteoarthritis by Periarticular Knee Osteotomy

“…Evidence from the literature: To evaluate the risk factors for surgical site infection after HTO, Kawata et al 59 . retrospectively analyzed the data of 12,853 patients undergoing HTO from 2010 to 2017 in a Japanese national database and found that 195 patients had surgical site infections, and 50 patients had deep infections.…”

“…Evidence from the literature: To evaluate the risk factors for surgical site infection after HTO, Kawata et al . 59 retrospectively analyzed the data of 12,853 patients undergoing HTO from 2010 to 2017 in a Japanese national database and found that 195 patients had surgical site infections, and 50 patients had deep infections. Male sex, old age (>50 years), long anesthesia time (>3.5 hours), and the use of artificial bone graft materials were independent risk factors for postoperative infections of HTO.…”