Risk factors for surgical site infections after open reduction and internal fixation of acetabulum fracture in the west of Iran

Incidence and risk factors associated with surgical site infection in acetabular fracture patients: An experience from north India

Introduction

Nearly 5-7% of patients undergoing surgical management of acetabular fractures develop surgical site infection (SSI) which is one of the most important factors affecting the hospital stay, success of procedure and overall patient satisfaction. Systematic studies to identify the risk factors and their control could help to reduce the surgical site infection rate considerably. The present study assessed the incidence and risk factors related with SSI in patients undergoing surgical management of acetabular fractures at our center.

Methods and materials

This retrospective record review included a total of 228 adult acetabular fracture patients (≥18 years) who were managed surgically. Demographic and clinical profile of the patients was noted and cases developing SSI. Univariate and multivariate association of different demographic and clinical factors was done to identify factors significantly associated with SSI. Univariate analysis was done using chi-square test. Multivariate assessment was done using binary logistic regression.

Results

Mean age of patients was 36.40 ± 14.18 years. Majority of patients were males (83.8 %). Incidence of SSI was 6.1 %. On univariate analysis, age ≥40 years, occupation service/business, fall from height, BMI >25 kg/m2, presence of associated injury, ≥48 h gap between injury and surgery, smoking and use of Kocher-Langenbeck approach for surgery were found to be significantly associated with an increased risk of SSI. However, on multivariate analysis only age >40 years (OR = 3.72; 95 % CI = 1.00-3.75; p = 0.049) and BMI>25.0 kg/m2 (OR = 0.20; 95 % CI = 0.05-0.85; p = 0.029) were the significant predictors of SSI.

Conclusions

This study identified that surgical site infection rates show a secular stagnating trend. There were almost no modifiable risk factors that could reduce this incidence, however, a strict post-operative care in patients with age >40 years and BMI>25 kg/m2 could help to change the direction of these trends.

Rates and risk factors of complications associated with operative treatment of pelvic fractures

PURPOSE

Post-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and knowledge on risk factors is limited. This study aims to identify the most common post-operative complications and their possible risk factors following pelvic fracture surgery.

METHODS

A retrospective cohort study was performed in two level-1 trauma centers in the Netherlands between January 2015 and January 2021. Included patients were all adult patients (≥ 18 years) with an operatively treated pelvic fracture (pelvic ring and/or acetabular fractures). Post-operative complications included surgical site infections (SSI), material-related complications, neurological complications, malunion/non-union and performed reoperations. A forward stepwise multivariable logistic regression analysis was used to identify any risk factors associated with these complications.

RESULTS

Complications occurred in 55 (24%) of the 233 included patients. SSI's were most common, occurring in 34 (15%) patients. Duration of surgery (odds ratio 1.01 per minute, 95% confidence interval 1.00-1.01) and obesity (odds ratio 1.10 per BMI point, 95% confidence interval 1.29-7.52) were independent risk factors for development of SSI. Less common post-operative complications were material-related complications (8%) and neurological damage (5%).

CONCLUSION

Limiting operation time by using less invasive and less time-consuming surgical approaches may reduce the risk of SSI. More awareness and post-operative screening for early signs of SSI is mandatory, especially in obese patients. Future research should include large prospective patient cohorts to determine risk factors for other post-operative complications associated with pelvic fracture surgery.