Institutional and Seasonal Variations in the Incidence and Causative Organisms for Posttraumatic Infection following Open Fractures

Sagi, H. Claude; Donohue, David; Cooper, Seth A.; Barei, David P.; Siebler, Justin; Archdeacon, Michael T.; Sciadini, Marcus F.; Roméo, Michèle; Bergin, Patrick F.; Higgins, Thomas F.; Mir, Hassan R.; Infection, Joint

doi:10.1097/bot.0000000000000730

Cited by 31 publications

(31 citation statements)

References 17 publications

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“…Our search identified 2191 unique documents. Eighteen studies met all criteria and were included in this review . Figure represents the process of inclusion and exclusion.…”

Section: Resultsmentioning

confidence: 99%

“…For patients, the impact of post‐operative infection can be high, involving longer hospital stays, increased readmission, inflated healthcare costs, pain, functional loss, extended antibiotic use and repeat surgery . Despite a great deal of prior research on risk factors for infection, there has been no systematic review to date on the role of environmental temperature in orthopaedic post‐operative infection. Identifying seasonal infection surges during the warmer months may help clinicians to improve patient outcomes by guiding approaches to wound care, infection surveillance, antibiotic choice and procedure timing.…”

Section: Introductionmentioning

confidence: 99%

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Association between higher ambient temperature and orthopaedic infection rates: a systematic review and meta‐analysis

Vickers

Pelecanos

Tran

et al. 2019

ANZ Journal of Surgery

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Introduction: Many infectious diseases display seasonal variation corresponding with particular conditions. In orthopaedics a growing body of evidence has identified surges in postoperative infection rates during higher temperature periods. The aim of this research was to collate and synthesize the current literature on this topic. Methods: A systematic review and meta-analysis was performed using five databases (PubMed, Embase, CINAHL, Web of Science and Central (Cochrane)). Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. Odds ratios (ORs) were calculated from monthly infection rates and a pooled OR was generated using the DerSimonian and Lairds method. A protocol for this review was registered with the National Institute for Health Research International Prospective Register of Systematic Reviews (CRD42017081871). Results: Eighteen studies analysing over 19 000 cases of orthopaedic related infection met inclusion criteria. Data on 6620 cases and 9035 controls from 12 studies were included for meta-analysis. The pooled OR indicated an overall increased odds of post-operative infection for patients undergoing orthopaedic procedures during warmer periods of the year (pooled OR 1.16, 95% confidence interval 1.04-1.30). Conclusion: A small but significantly increased odds of post-operative infection may exist for orthopaedic patients who undergo procedures during higher temperature periods. It is hypothesized that this effect is geographically dependent and confounded by meteorological factors, local cultural variables and hospital staffing cycles.

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“…Our search identified 2191 unique documents. Eighteen studies met all criteria and were included in this review . Figure represents the process of inclusion and exclusion.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between higher ambient temperature and orthopaedic infection rates: a systematic review and meta‐analysis

Vickers

Pelecanos

Tran

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

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“…A seasonal effect on the incidence of infectious complications after different types of surgery has been increasingly described in recent literature [8][9][10][11][12][13][14][15][16][17][18]. Numerous publications have documented a significantly higher incidence of wound complications during the summer months [10,16,[19][20][21]. The suggestion is that in summer, the warmer temperatures and higher humidity of the air, provide optimal conditions for proliferation of bacteria outside of the operation room.…”

Section: Introductionmentioning

confidence: 99%

Seasonal effect on the incidence of post-operative wound complications after trauma-related surgery of the foot, ankle and lower leg

Sanders

Hul

Kistemaker

et al. 2020

Arch Orthop Trauma Surg

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Introduction Post-operative wound complications remain among the most common complications of orthopedic (trauma) surgery. Recently, studies have suggested environmental factors such as season to be of influence on wound complications. Patients operated in summer are reported to have more wound complications, compared to other seasons. The aim of this study was to identify if "seasonality" was a significant predictor for wound complications in this cohort of trauma-related foot/ankle procedures. Materials and methods This retrospective cohort study included all patients undergoing trauma-related surgery (e.g. fracture fixation, arthrodesis, implant removal) of the foot, ankle or lower leg. Procedures were performed at a Level 1 Trauma Center between September 2015 until March 2019. Potential risk factors/confounders were identified using univariate analysis. Procedures were divided into two groups: (1) performed in summer (June, July or August), (2) other seasons (September-May). The number of surgical wound complications (FRIs, SSIs or wound dehiscence) was compared between the two groups, corrected for confounders, using multivariate regression. Results A total of 599 procedures were included, mostly performed in the hindfoot (47.6%). Patients were on average 46 years old, and mostly male (60.8%). The total number of wound complications was 43 (7.2%). Age, alcohol abuse, open fracture and no tourniquet use were independent predicting factors. No difference in wound complications was found between summer and other seasons, neither in univariate analysis [4 (3.2%) vs 39 (8.2%), p = 0.086] nor when corrected for predicting factors as confounders (p = 0.096).Conclusions No seasonality could be identified in the rate of wound complications after trauma surgery of the lower leg, ankle and foot in this cohort. This lack of effect might result from the temperate climate of this cohort. Larger temperature and precipitation differences may influence wound complications to a larger extent. However, previous studies suggesting seasonality in wound complications might also be based on coincidence.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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“…Staphylococcus aureus and coagulase-negative staphylococci are the primary infecting organisms following orthopaedic surgery and these too display seasonality based on meteorological and calendar patterns. [13][14][15] Humidity has also been implicated in the severity of acute haematogenous osteomyelitis, 16,17 suggesting that in addition to temperature other features such as moisture, rainfall and air quality also influence the pathogenicity of commensal skin flora in orthopaedic patients. [13][14][15] Humidity has also been implicated in the severity of acute haematogenous osteomyelitis, 16,17 suggesting that in addition to temperature other features such as moisture, rainfall and air quality also influence the pathogenicity of commensal skin flora in orthopaedic patients.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Prior epidemiological studies in orthopaedics have placed particular emphasis on the role that higher ambient temperatures might have on surgical site infection with increased risk identified in spinal surgery, 8,9 lower limb joint replacement [10][11][12] and fracture fixation. [13][14][15] Humidity has also been implicated in the severity of acute haematogenous osteomyelitis, 16,17 suggesting that in addition to temperature other features such as moisture, rainfall and air quality also influence the pathogenicity of commensal skin flora in orthopaedic patients.…”

Section: Introductionmentioning

confidence: 99%

Humidity a potential risk factor for prosthetic joint infection in a tropical Australian hospital

Armit

Vickers

Parr

et al. 2018

ANZ Journal of Surgery

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Background: Many pathogens of importance, including the staphylococcal species of concern in orthopaedics, demonstrate seasonal variations influenced by environmental factors. The aim of this study was to investigate the role of humidity as a risk factor for deep prosthetic joint infection following total knee arthroplasty (TKA) in a tropical Australian hospital.Methods: A retrospective cohort study of all TKAs performed over a 13-year period was conducted at the author's institution. Univariate analysis was used to individually assess for a range of risk factors including humidity >60% and apparent temperature >30 C (86 F). Odds ratios (ORs) were reported. P-values <0.25 were considered as potentially important risk factors and P-values <0.05 were considered statistically significant. Results: A total of 1058 primary TKAs were performed with a deep prosthetic joint infection incidence of 2.7%. Four potential risk factors were identified with P-values <0.25: (i) humidity >60% (OR 1.4; 95% confidence interval (CI) 0.68-3.04; P = 0.221); (ii) apparent temperature >30 C (86 F) (OR 2.4; 95% CI 0.56-10.1; P = 0.174); (iii) male gender (OR 2.2; 95% CI 1.02-4.81; P = 0.057); and (iv) American Society of Anesthesiologists score of III or IV (OR 2.1; 95% CI 1.00-4.49; P = 0.064). Conclusion: Humidity and apparent temperature may be potentially important risk factors for infection following TKA.

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Institutional and Seasonal Variations in the Incidence and Causative Organisms for Posttraumatic Infection following Open Fractures

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 31 publications

References 17 publications

Association between higher ambient temperature and orthopaedic infection rates: a systematic review and meta‐analysis

Association between higher ambient temperature and orthopaedic infection rates: a systematic review and meta‐analysis

Seasonal effect on the incidence of post-operative wound complications after trauma-related surgery of the foot, ankle and lower leg

Humidity a potential risk factor for prosthetic joint infection in a tropical Australian hospital

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