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van de Voort JC, Brekelmans W, Ritchie ED, Leijnen M. Preventing Surgical Site Infections in Geriatric Ankle Fracture Surgery with Closed-Incision Vacuum Therapy: A Pilot Study. Adv Skin Wound Care 2024; 37:1-4. [PMID: 38506586 DOI: 10.1097/asw.0000000000000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Ankle fractures are among the most common fractures in older adult patients that need surgical treatment. The risk of surgical site infections (SSIs) after ankle fracture surgery ranges between 0.5% and 30%; SSI incidence is higher among older adults. Further, SSIs have significant consequences for subjective functional outcomes and create a need for prolonged intravenous antibiotic therapy and wound care. Accordingly, it is critical to determine risk factors for and establish optimal postoperative wound care to prevent SSIs. OBJECTIVE The aim of the pilot study was to examine the feasibility of closed-incision vacuum therapy (CIVT) to reduce rates of SSI in older adults. METHODS The authors performed a pilot study of a CIVT system in a population of 10 older adult patients after ankle fracture surgery. RESULTS Nine patients experienced uncomplicated wound healing of the lateral incision. One patient (10%) developed an SSI after premature removal of the vacuum system because of technical failure. Six weeks postoperation, overall satisfaction with the CIVT was high; none of the participants complained of incapacitating discomfort or disruptive limitations in postsurgical recovery. CONCLUSIONS The authors conclude that CIVT is a feasible, safe, and generally well-tolerated therapy to prevent SSIs in postoperative wound healing after open reduction and internal fixation in older adult patients after ankle fracture.
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Affiliation(s)
- Jan C van de Voort
- At Alrijne Hospital, Leiderdorp, the Netherlands, Jan C. van de Voort, MD, is Surgical Resident; Wouter Brekelmans, MD, is Head of the Alrijne Wound Center; and Ewan D. Ritchie, MD, and Michiel Leijnen, MD, are Trauma Surgeons
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Bergström J, Möller Rydberg E, Wennergren D, Svensson Malchau K. Incidence and Risk Factors for Surgical Site Infection in Ankle Fractures: An Observational Study of 480 Patients in Sweden. J Clin Med 2023; 12:6464. [PMID: 37892601 PMCID: PMC10607575 DOI: 10.3390/jcm12206464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is a frequently reported complication after ankle fracture surgery. To our knowledge, no study has been conducted on its incidence in Sweden. The present study aimed to determine the incidence of, risk factors for, and most common causative pathogen of SSI. METHODS Patients who underwent primary surgery for an ankle fracture between 1 September 2017 and 31 August 2019 at the Sahlgrenska University Hospital were identified. Data on potential SSI risk factors and clinical outcome (infected/non-infected) were retrieved from medical records. Cox regression analysis and descriptive statistics were used. RESULTS Of the 480 reviewed patients, 49 developed SSI (10.2%), of which 35 (7.3%) were superficial and 14 (2.9%) were deep. Open fractures (p < 0.001) and age (p = 0.016) were statistically significant risk factors for SSI in the univariate analysis. In the multivariable analysis, only open fracture was statistically significant (HR = 3.0; 95% C.I. = 1.3-6.9, p = 0.013). Cases of Staphylococcus aureus (S. aureus) were most common (n = 12, 24.5%). Methicillin resistance was uncommon (n = 2, 4.1%). CONCLUSIONS An incidence of 10.2% was established, which is comparable to international findings. Infection monitoring is an important part of tackling the global challenge of antibiotic resistance. Future prospective studies to further establish risk factors are warranted to decrease the incidence of SSI.
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Affiliation(s)
- Johanna Bergström
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
| | - Karin Svensson Malchau
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (E.M.R.); (D.W.); (K.S.M.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 413 80 Gothenburg, Sweden
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Kang HJ, Kwon YM, Byeon SJ, Kim HN, Sung IH, Subramanian SA, Kim SJ. Trends and Risk Factors for Surgical Site Infection after Treatment of the Ankle Fracture: National Cohort Study. J Clin Med 2023; 12:4215. [PMID: 37445250 DOI: 10.3390/jcm12134215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Surgical site infection (SSI) is a major complication after the surgical treatment of ankle fractures that can result in catastrophic consequences. This study aimed to determine the incidence of SSI in several cohorts from national insurance databases over the past 12 years and identify its predictors. The claimed data for patients (n = 1,449,692) with ankle fractures between 2007 and 2019 were investigated, and a total of 41,071 patients were included in the final analysis. The covariates included were age, sex, season, fracture type (closed vs. open), type of surgical fixation procedure, and comorbidities of each patient. All subjects were divided into two groups according to the SSI after the surgical fixation of the ankle fracture (no infection group vs. infection group). The number of SSIs after the surgical treatment of ankle fractures was 874 (2.13%). Open fractures [odds ratio, (OR) = 4.220] showed the highest risk for SSI, followed by the male sex (OR = 1.841), an increasing number of comorbidities (3-5, OR = 1.484; ≥6, OR = 1.730), a history of dementia (OR = 1.720) or of myocardial infarction (OR = 1.628), and increasing age (OR = 1.010). The summer season (OR = 1.349) showed the highest risk among the four seasons for SSI after ankle fracture surgery.
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Affiliation(s)
- Hwa-Jun Kang
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Young-Min Kwon
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sun-Ju Byeon
- Department of Pathology, Yuseong Sun Hospital, Daejeon 34084, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul 04763, Republic of Korea
| | - Sivakumar Allur Subramanian
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
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García Cardona C, Bernaus Johnson MC, Martínez Ros J, Hernández-Gonzalez N, Auñon Rubio Á, Anglès Crespo F, Arteagoitia-Colino I, Coifman-Lucena I, Esteban-Moreno J, Moral Escudero E, Gómez García L, Nóvoa Martínez R, Ortega Columbrans A, Veloso Duran M, Font-Vizcarra L. Enterobacter cloacae Infection After Surgical Treatment of Ankle Fractures, a Multicenter Observational Study. Foot Ankle Int 2023; 44:424-430. [PMID: 36923994 DOI: 10.1177/10711007231157688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Infection is one of the challenging complications after open reduction and internal fixation for ankle fractures. Previously published case series conclude that Staphylococcus aureus is the most frequent causative microorganism. An unexpected increase in Enterobacter cloacae infections after this surgery was observed in a preliminary analysis of data at the promoting center of the study. In traumatology, its incidence has been reported in chronic osteomyelitis, prosthetic infections, septic osteoarthritis, open fractures in children and adults, and fractures other than the ankle. Because of this unexpected finding, we decided to perform this study to analyze the demographic and microbiological variables of acute osteosynthesis infection after ankle fracture and determine the distinctive features of the patients with E cloacae infection. METHODS We performed a retrospective multicenter study including 4 university hospitals. All patients diagnosed with acute osteosynthesis infection after ankle fracture fixation between January 2015 and December 2018 were included. We analyzed demographic data, type of fracture, surgical technique, and microorganisms responsible for the infection. We performed a descriptive statistical analysis of the variables. Univariate and multivariate regression analysis were performed to compare patients with E cloacae infection to patients with infection caused by other microorganisms. RESULTS A total of 65 patients were included. A predominance of polymicrobial infections (24.62%), followed by infections caused by S aureus (23.07%) and E cloacae (23.07%) was observed. When E cloacae isolated in polymicrobial infections were added, the incidence of E cloacae as a causative microorganism increased to 32.3%. Patients with E cloacae infection were older (64/53, P = .008) and had a higher requirement of negative-pressure therapy after surgical debridement (71%/40%, P = .017). CONCLUSION A high incidence of E cloacae infections was observed. Patients with E cloacae infection were generally older and required a higher use of negative-pressure therapy after debridement. LEVEL OF EVIDENCE Level V, mechanism-based reasoningr.
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Affiliation(s)
- Carlos García Cardona
- Department of Orthopedics and Traumatology, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Martí Carles Bernaus Johnson
- Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Javier Martínez Ros
- Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Nerea Hernández-Gonzalez
- Department of Orthopedics and Traumatology, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain
| | - Álvaro Auñon Rubio
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francesc Anglès Crespo
- Department of Orthopedics and Traumatology, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Iraia Arteagoitia-Colino
- Department of Orthopedics and Traumatology, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain
| | - Ismael Coifman-Lucena
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jaime Esteban-Moreno
- Department of Microbiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Encarnación Moral Escudero
- Osteoarticular Infection Unit, Department of Infectious Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Lucía Gómez García
- Osteoarticular Infection Unit, Department of Infectious Diseases, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Ricardo Nóvoa Martínez
- Department of Orthopedics and Traumatology, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain
| | - Ana Ortega Columbrans
- Department of Orthopedics and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Margarita Veloso Duran
- Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
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Zhao H, Meng J, Sun T, Wan Z, Qin S, Zhang F, Hou Z. Risk factors for deep surgical site infection following surgically treated peri-ankle fractures: a case-control study based on propensity score matching. J Orthop Surg Res 2022; 17:542. [PMID: 36522748 PMCID: PMC9753310 DOI: 10.1186/s13018-022-03436-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS This study aims to identify the risk factors for deep surgical site infection (DSSI) following surgically treated peri-ankle fractures. METHODS We performed a retrospective case-control study using the propensity score matching (PSM) method in 1:2 ratio, based on the 6 baseline variables, including age, gender, living area, insurance type, fracture location and surgical date. Data on patients who underwent surgical treatment of peri-ankle fractures were collected by inquiring their hospitalization medical records and operative records, as well as the laboratory reports. Conditional logistic regression analysis was performed to identify the risk factors for DSSI. RESULTS A total of 2147 patients were eligibly included and 74 had a DSSI, indicating an incidence rate of 3.4%. After PSM, 70 cases of DSSI and 140 controls without DSSI were matched, constituting the study cohort. The univariate analyses showed significant differences between groups in terms of history of any surgery, time to operation, surgical wound classification, smoking, alcohol drinking, RBC count, hemoglobin concentration and hematocrit (%). The conditional logistic regression analysis showed time to operation of < 4 or > 9 (vs 4-9 days); unclean wound, current smoking, high-energy injury mechanism and lower hematocrit were independent risk factors for DSSI. CONCLUSIONS Timely modification of smoking and hematocrit (%), and limiting operation within a rational time frame for an optimized soft tissue condition, may provide potential clinical benefits for SSI prevention.
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Affiliation(s)
- Haitao Zhao
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Trauma Center, The 3rd Hospital of Hebei Medical University, No 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China ,grid.452209.80000 0004 1799 0194Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Jinghong Meng
- grid.452209.80000 0004 1799 0194Department of Rheumatology and Immunology, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Tao Sun
- grid.452209.80000 0004 1799 0194Department of Bone Tumor, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Zihan Wan
- grid.256883.20000 0004 1760 8442College of Basic Medicine, Hebei Medical University, Shijiazhuang, 050000 Hebei People’s Republic of China
| | - Shiji Qin
- grid.452209.80000 0004 1799 0194Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Fengqi Zhang
- grid.452209.80000 0004 1799 0194Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Zhiyong Hou
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Trauma Center, The 3rd Hospital of Hebei Medical University, No 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
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Bullock TS, Gutierrez-Naranjo JM, DelBello RG, Karia RA, Zelle BA. Outpatient surgery in patients with ankle fractures minimises hospital admissions and utilisation of healthcare resources. INTERNATIONAL ORTHOPAEDICS 2020; 45:2395-2400. [PMID: 32770348 PMCID: PMC7414283 DOI: 10.1007/s00264-020-04768-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022]
Abstract
Purpose The recent outbreak of the novel coronavirus (SARS-CoV-2) has emphasised the need to minimise hospital admissions and utilisation of healthcare resources. The purpose of this study was to examine the outcomes of an outpatient surgery protocol for acute closed ankle fractures. Methods In this retrospective study, 262 patients underwent outpatient surgery for their closed ankle fractures at our level-1 trauma centre. A total of 196 patients met our inclusion criteria and were ultimately included in the final analysis. Our primary outcomes’ measures included post-operative admission to the emergency department within 30 days after surgery and unplanned hospital readmission within 30 days after surgery. Our secondary outcome measure included the incidence of surgical site infection (SSI) within 12 weeks after surgery. Results Thirty-two patients (16.3%) had an unplanned emergency department visit within 30 days of fracture fixation and two patients (1.0%) required hospital readmission within 30 days of their surgery. Sixteen patients (8.2%) developed SSI, which included 11 (5.6%) superficial and five (2.6%) deep infections. Conclusion Strategic outpatient management of acute closed ankle fractures is associated with acceptable rates of unplanned emergency department visits, hospital readmissions, and SSIs. In the context of the recent SARS-CoV-2 outbreak, outpatient management of these injuries may aide in the mitigation of nosocomial infections and the preservation of finite healthcare resources.
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Affiliation(s)
- Travis S Bullock
- Long School of Medicine, UT Health San Antonio, San Antonio, TX, 78229-3900, USA
| | - Jose M Gutierrez-Naranjo
- Department of Orthopaedics, UT Health San Antonio, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229-3900, USA
| | - Robert G DelBello
- Long School of Medicine, UT Health San Antonio, San Antonio, TX, 78229-3900, USA
| | - Ravi A Karia
- Department of Orthopaedics, UT Health San Antonio, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229-3900, USA
| | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229-3900, USA.
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Liu X, Dong Z, Li J, Feng Y, Cao G, Song X, Yang J. Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study. J Orthop Surg Res 2019; 14:382. [PMID: 31752900 PMCID: PMC6873468 DOI: 10.1186/s13018-019-1449-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background Geriatric hip fracture is a common type of osteoporotic fracture with high mortality and disability; surgical site infection (SSI) can be a devastating complication of this injury. By far, only a few studies identified easily remediable factors to reduce infection rates following hip fracture and less researches have focused on geriatric patients. The objective of this study was to identify potentially modifiable factors associated with SSI following geriatric hip fracture surgery. Methods This retrospective, multicenter study involves three level I hospitals. A total of 1240 patients (60 years or older) underwent hip surgery with complete data were recruited between January 2016 and June 2018. Demographics information, medications and additional comorbidities, operation-related variables, and laboratory indexes were extracted and analyzed. Receiver operating characteristic (ROC) analysis was performed to detect the optimum cut-off value for quantitative data. Univariate and multivariate logistic analysis model were performed respectively to identify the independent predictors. Results Ninety-four (7.58%) patients developed SSI in this study, and 76 (6.13%) had superficial infection, while 18 (1.45%) were diagnosed with deep infection. Results of univariate and multivariate analysis showed age > 79 years (OR, 2.60; p < 0.001), BMI > 26.6 kg/m2 (OR, 2.97; p < 0.001), operating time > 107 min (OR, 2.18; p = 0.001), and ALB < 41.6 g/L (OR, 2.01; p = 0.005) were associated with an increased incidence of SSI; drainage use (OR, 0.57; p = 0.007) could reduce the incidence of wound infection for patients after geriatric hip fracture. Conclusion Accurate modifiable variables, operating time > 107 min, serum albumin < 41.6 g/L, BMI > 26.6 kg/m2, and age > 79 years could be applied to distinguish geriatric patients with high-risk of postoperative surgical site infection.
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Affiliation(s)
- Xiaopo Liu
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China.
| | - Zhijie Dong
- Department of Orthopaedic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, 063000, People's Republic of China
| | - Jun Li
- Second Department of Orthopaedic Surgery, First Hospital of Hebei Medical University, Shijiazhuang, Hebei, 063000, People's Republic of China
| | - Yunbo Feng
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Guolong Cao
- Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Xin Song
- Department of Radiology, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
| | - Jie Yang
- First Department of Geriatric, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China
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Effect of Obesity on Perioperative Complications, Hospital Costs, and Length of Stay in Patients With Open Ankle Fractures. J Am Acad Orthop Surg 2019; 27:e529-e534. [PMID: 30299341 DOI: 10.5435/jaaos-d-17-00860] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The objective of this study was to examine the effect of obesity on perioperative complications and the cost of surgical management of open ankle fractures. METHODS This study examined data from the National Inpatient Sample. The primary outcome variables assessed were occurrence of any complication, complication subtype, length of stay, and total hospital costs. RESULTS Patients with obesity accounted for 10.1% (n = 8.972) of the total cohort. After adjusting for patient and hospital characteristics, patients with obesity exhibited higher odds of any complication, as well as longer length of stay and higher total costs. CONCLUSION As our understanding of the association between complications and cost of managing open ankle fractures in patients with obesity improves, future research should strive to improve patient outcomes and decrease cost of care through efforts made to prevent complications in patients with obesity.
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Bai Y, Zhang X, Tian Y, Tian D, Zhang B. Incidence of surgical-site infection following open reduction and internal fixation of a distal femur fracture: An observational case-control study. Medicine (Baltimore) 2019; 98:e14547. [PMID: 30762800 PMCID: PMC6408021 DOI: 10.1097/md.0000000000014547] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Surgical-site infection (SSI) is a common complication in orthopedic surgery; however, SSI after surgically managed distal femur fractures was not well studied. The aim of this study was to investigate the incidence of SSI and identify some modifiable and nonmodifiable risk factors.The patients' electronic medical records (EMRs) were reviewed to identify those who sustained a distal femur fracture and treated by open reduction and internal fixation (ORIF) between March 2014 and February 2018. SSI was defined based on the Centers for Disease Control criteria and confirmed according to the descriptions in EMR. Univariate and multivariate logistic regression models were used to determine the independent risk factors associated with SSI.Totally, EMRs of 665 patients who underwent ORIF of distal femur fractures were reviewed and 24 SSIs were found, indicating the overall incidence of SSI was 3.6%. The rate of deep SSI was 1.2% and superficial SSI was 2.4%. Staphylococcus aureus was the most common causative pathogen, either alone (7/15, 46.7%) or as a mixed infection (3/15, 20%), followed by mixed bacterial (4/15, 26.7%) and S epidermidis (2/15, 13.3%) and others. Patients with SSI had approximately twice the length of hospital stay as those without SSIs (29.0 vs 16.0 days, P < .001). Open fracture, temporary use of external fixation, obesity, smoking, diabetes mellitus, and preoperative reduced albumin level were identified as independent risk factors associated with SSI, and current smoking and preoperative reduced albumin level were the true modifiable factors.Patients should be encouraged to cease smoking as early as possible and increase the good-quality protein intake to reduce or prevent the occurrence of SSI. An explanation of the nonmodifiable risk factors should be included when patients are counseled about their increased risk of SSI.
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Affiliation(s)
- Yanbin Bai
- Department of Orthopaedic Surgery
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiong Zhang
- Department of Orthopaedic Surgery
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ye Tian
- Department of Orthopaedic Surgery
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dehu Tian
- Department of Orthopaedic Surgery
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bing Zhang
- Department of Orthopaedic Surgery
- Department of Hand Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Meng J, Sun T, Zhang F, Qin S, Li Y, Zhao H. Deep surgical site infection after ankle fractures treated by open reduction and internal fixation in adults: A retrospective case-control study. Int Wound J 2018; 15:971-977. [PMID: 30091528 PMCID: PMC7949792 DOI: 10.1111/iwj.12957] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 01/17/2023] Open
Abstract
Information on ankle fractures is limited. The purpose of this study was to investigate the incidence and risk factors for deep surgical site infection (DSSI) after open reduction and internal fixation (ORIF). Adult patients who underwent ORIF for an ankle fractures at 3 level-I centres between January 2013 and June 2017 were included. Data on demographic, injury-related, and surgery-related variables and biochemical indexes from the laboratory were collected from patients' electronic medical records. Univariate analysis and multivariate logistic regression analysis model were used to perform the data analysis through SPSS 19.0. Within 1-year postoperatively, 2.83% (74/2617) of cases developed DSSI, with the earliest occurring at the 4th and latest at 147th day. Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and methicillin-susceptible Staphylococcus aureus were the top 3 bacteria, causing 73% (37/51) of all the cases. Age (45-64 and ≥65 years), current smoking status, chronic heart disease, lower preoperative albumin level, open injury, and prolonged surgical duration were identified to be independently associated with DSSI occurrence. Preoperative active supplementation of nutrition, immediate smoking cessation, and optimisation of an operative plan for the reduction of surgical duration were feasible measures for DSSI prevention following ORIF of ankle fractures.
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Affiliation(s)
- Jinghong Meng
- Department of Rheumatology and ImmunologyThe 3rd Hospital of Hebei Medical UniversityShijiazhuangPR China
| | - Tao Sun
- Department of Bone TumorThe 3rd Hospital of Hebei Medical UniversityShijiazhuangPR China
| | - Fengqi Zhang
- Department of Foot and Ankle SurgeryThe 3rd Hospital of Hebei Medical UniversityShijiazhuangPR China
| | - Shiji Qin
- Department of Foot and Ankle SurgeryThe 3rd Hospital of Hebei Medical UniversityShijiazhuangPR China
| | - Yansen Li
- Department of Foot and Ankle SurgeryThe 3rd Hospital of Hebei Medical UniversityShijiazhuangPR China
| | - Haitao Zhao
- Department of Foot and Ankle SurgeryThe 3rd Hospital of Hebei Medical UniversityShijiazhuangPR China
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Sun Y, Wang H, Tang Y, Zhao H, Qin S, Xu L, Xia Z, Zhang F. Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: A retrospective multicenter study. Medicine (Baltimore) 2018; 97:e9901. [PMID: 29443762 PMCID: PMC5839807 DOI: 10.1097/md.0000000000009901] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Information on surgical site infection (SSI) after surgical treatment of ankle fracture is limited and remains controversial. The purpose of the present study was to determine the incidence and risk factors for SSI after open reduction and internal fixation (ORIF) of ankle fracture. Patients who underwent ORIF for ankle fracture at 3 centers between January 2015 and December 2016 were included. The potential risk factors for SSI included demographic variables, including age, sex, body mass index (BMI), hypertension, diabetes mellitus, heart disease, smoking, and excessive alcohol intake; blood test variables including preoperative white blood cell count, neutrophil count, red blood cell count, hemoglobin, total protein, albumin and globulin; injury- and surgery-related variables, including duration of operation (minutes), intraoperative blood loss, surgeon level, fracture site, accompanied dislocation, use of a drainage tube, and antibiotic use. Factors related with SSI occurrence were investigated by univariate analysis, and then by multivariate analysis. During hospitalization, 4.37% (66/1511) of patients developed SSI, which was deep in 1.32% (20/1510) and superficial in 3.05% (46/1510). The most common causative agent was polymicrobial (causing approximately half of all SSIs), followed by methicillin-resistant Staphylococcus aureus (MRSA). Multivariate analysis revealed that the significant risk factors for SSI occurrence were open injury, advanced age, incision cleanliness II - IV, high-energy injury, more experienced surgeon level, greater BMI, chronic heart disease, history of allergy, and preoperative neutrophil count > 75%. Preoperative preventative measures should be taken in patients with these conditions to lower the incidence of SSI after ORIF of ankle fracture. LEVEL OF EVIDENCE Level III - Retrospective Comparative Study.
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Affiliation(s)
- Yaning Sun
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University
| | - Huijuan Wang
- Department of Histology and Embryology, Hebei Medical University, Shijiazhuang
| | - Yuchao Tang
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University
| | - Haitao Zhao
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University
| | - Shiji Qin
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University
| | - Lihui Xu
- Department of Foot and hand Surgery, Xingtai People‘s Hospital, Xingtai
| | - Zhiyong Xia
- Department of Orthopedics 4, Handan Branch of the Jizhong Energy Fengfeng Group General Hospital, Handan, Hebei, China
| | - Fengqi Zhang
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University
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Sun R, Li M, Wang X, Li X, Wu L, Chen Z, Chen K. Surgical site infection following open reduction and internal fixation of a closed ankle fractures: A retrospective multicenter cohort study. Int J Surg 2017; 48:86-91. [PMID: 29050964 DOI: 10.1016/j.ijsu.2017.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Identification of risk factors for surgical site infection (SSI) after surgical ankle fractures was important, but related evidence was inadequate. This study was conducted to investigate the incidence and risk factors for SSI after open reduction and internal fixation (ORIF) of a closed ankle fractures. METHODS Patients who underwent ORIF for a closed ankle fractures at 3 centers between July 2015 and January 2017 were included. Electronic medical recordings (EMR) and Picture Archiving and Communication Systems (PACS) were inquired for information on patients' clinical and radiographic characteristics. The potential factors include 4 aspects: demographics, injury-related, surgery-related and biochemical indictors. Factors related with SSI were analyzed by univariate and further by multivariate logistic regression model. RESULTS During the hospitalization, 3.7% (46/1247) of patients developed SSI, with 1.12% (14/1247) for deep and 2.57% (32/1247) for superficial SSI. Approximately half of SSIs were caused by Methicillin-resistant Staphylococcus aureus (MRSA). After adjustment for confounding factors, higher body mass index (BMI), surgeon level (residents or treating surgeon), surgical duration>130mins, delayed surgery, preoperative TP < 60 g/L were significant risk factor or predictors for SSI occurrence. CONCLUSIONS After comprehensive evaluation of patients medical conditions, immediate operation by a surgeon with more expertise could effectively reduce SSI occurrence.
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Affiliation(s)
- Ran Sun
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Mingqiao Li
- Department of the Orthopaedics, The Second People' Hospital of Hengshui, Hengshui, Hebei, 053000, PR China.
| | - Xiaofeng Wang
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Xiaodong Li
- Department of Orthopaedics, Handan Central Hospital, Handan, Hebei, 056002, PR China.
| | - Lumei Wu
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Zheng Chen
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Kang Chen
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
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13
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Duan X, Kadakia AR. Operative Treatment of Posterior Malleolar Fractures. Open Orthop J 2017; 11:732-742. [PMID: 28979587 PMCID: PMC5620409 DOI: 10.2174/1874325001711010732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/16/2016] [Accepted: 07/23/2016] [Indexed: 12/11/2022] Open
Abstract
Fractures of the posterior malleolus can occur in conjunction with fibular and medial malleolar fractures or in isolation. The indications for fixation of the posterior malleolus remain controversial except for the fragment sizes. A number of different surgical approaches and techniques for internal fixation of posterior malleolar fractures have been reported. Newer techniques such as direct exposure and plating of the posterior malleolus are chosen more frequently than traditional techniques of indirect reduction and percutaneous screw fixation. These attributes help to minimize the occurrence of postoperative complications.
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Affiliation(s)
- Xiaojun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, P.R, China
| | - Anish R Kadakia
- Department of Orthopedic Surgery, Northwestern University - Feinberg School of Medicine, Chicago, IL 60611, USA
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Olsen LL, Møller AM, Brorson S, Hasselager RB, Sort R. The impact of lifestyle risk factors on the rate of infection after surgery for a fracture of the ankle. Bone Joint J 2017; 99-B:225-230. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0344.r1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/04/2016] [Indexed: 11/05/2022]
Abstract
Aims Lifestyle risk factors are thought to increase the risk of infection after acute orthopaedic surgery but the evidence is scarce. We aimed to investigate whether smoking, obesity and alcohol overuse are risk factors for the development of infections after surgery for a fracture of the ankle. Patients and Methods We retrospectively reviewed all patients who underwent internal fixation of a fracture of the ankle between 2008 and 2013. The primary outcome was the rate of deep infection and the secondary outcome was any surgical site infection (SSI). Associations with the risk factors and possible confounding variables were analysed univariably and multivariably with backwards elimination. Results A total of 1043 patients were included; 64 (6.1%) had a deep infection and 146 (14.0%) had SSI. Obesity was strongly associated with both outcomes (odds ratio (OR) 2.21, p = 0.017 and OR 1.68, p = 0.032) in all analyses. Alcohol overuse was similarly associated, though significant only in unadjusted analyses. Surprisingly, smoking did not yield statistically significant associations with infections. Conclusion These findings suggest that obesity and possibly alcohol overuse are independent risk factors for the development of infection following surgery for a fracture of the ankle. This large study brings new evidence concerning these common risk factors; although prospective studies are needed to confirm causality. Cite this article: Bone Joint J 2017;99-B:225–30.
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Affiliation(s)
- L. L. Olsen
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
| | - A. M. Møller
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
| | - S. Brorson
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
| | - R. B. Hasselager
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
| | - R. Sort
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
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Fang C, Wong TM, Lau TW, To KK, Wong SS, Leung F. Infection after fracture osteosynthesis - Part I. J Orthop Surg (Hong Kong) 2017; 25:2309499017692712. [PMID: 28215118 DOI: 10.1177/2309499017692712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Bone and surgical site infections after osteosynthesis are notoriously difficult to manage and pose a tremendous burden in fracture management. In this article, we use the term osteosynthesis-associated infection (OAI) to refer to this clinical entity. While relatively few surgically treated fractures become infected, it is challenging to perform a rapid diagnosis. Optimal management strategies are complex and highly customized to each scenario and take into consideration the status of fracture union, the presence of hardware and the degree of mechanical stability. At present, a high level of relevant evidence is unavailable; most findings presented in the literature are based on laboratory work and non-randomized clinical studies. We present this overview of OAI in two parts: an examination of recent literature concerning OAI pathogenesis, diagnosis and classification and a review of treatment options.
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Affiliation(s)
- Christian Fang
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Tak-Man Wong
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China.,3 Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tak-Wing Lau
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Kelvin Kw To
- 2 Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Samson Sy Wong
- 2 Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Frankie Leung
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China.,3 Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Friedman J, Ly A, Mauffrey C, Stahel PF. Temporary transarticular K-wire fixation of critical ankle injuries at risk: a neglected "damage control" strategy? Orthopedics 2015; 38:122-7. [PMID: 25665111 DOI: 10.3928/01477447-20150204-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
High-energy ankle fracture-dislocations are at significant risk for postoperative complications. Closed reduction and temporary percutaneous transarticular K-wire fixation was first described more than 50 years ago. This simple and effective "damage control" strategy is widely practiced in Europe, yet appears largely forgotten and abandoned in the United States. Anecdotal opposing arguments include the notion that drilling K-wires through articular cartilage may damage the joint and contribute to postinjury arthritis. This article describes the experience in a US academic level I trauma center with transarticular pinning of selected critical ankle fracture-dislocations followed by delayed definitive fracture fixation once the soft tissues are healed. Median patient follow-up of 2 years showed that the transarticular pinning technique was performed safely, not associated with increased postoperative complication rates, and characterized by good subjective outcomes using the American Academy of Orthopaedic Surgeons Foot and Ankle Outcome Score questionnaire.
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