Multivariate analysis of determinants of postoperative wound infection in orthopaedic patients

Background A surgical site infection is a substantial cause of complications in patients. Different methods are being used to decrease surgical site infections; however, these infections still can cause complications, especially in patients undergoing longer operations ([ 3 hours). There is evidence that the efficacy of the scrubbing material fades after 3 hours. However, we do not know the longevity of hand cleanliness after application of scrubbing materials in a long operation. It can be postulated that if the surgeon's scrubbed hands are recolonized after a certain time, they may serve as a progressive source of contamination during surgery. Questions/purposes We asked: (1) Is there a correlation between surgical duration and hand contamination at the end of surgery? (2) At what point during surgery does hand contamination reach or exceed prescrub levels? Methods Three spine surgeons using the same scrubbing technique and materials consisting of chlorhexidine gluconate 1% solution and ethyl alcohol 61% w/w were enrolled in our study. Between December 2014 and April 2015, spine procedures of 3 hours or more, which were the One of the authors (PH) received funding from The San Diego Spine Foundation for this study. One of the authors certifies that he (BAA) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Nuvasive (San Diego, CA, USA), K2M (Leesburg, VA, USA), and DePuy Synthes (West Chester, PA, USA), and Ellipse (Aliso Viejo, CA, USA); an amount of USD 100,000 to 1000,000 from Nuvasive (San Diego, CA, USA); an amount of less than USD 10,000 from Ellipse (Aliso Viejo, CA, USA), Kspine (Leesburg, VA, USA), International Spine Study Group (Brighton, CO, USA), Nuvasive (San Diego, CA, USA), and K2M (Leesburg, VA, USA); Growing Spine Foundation (Milwaukee, WI, USA), San Diego Spine Foundation (San Diego, CA, USA), Scoliosis Research Society (Milwaukee, WI, USA), and Society of Lateral Access Surgery (San Diego, CA, USA). One of the authors certifies that he (GMM) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,000 to 1,000,000 from Nuvasive (San Diego, CA, USA); an amount of less than USD 10,000 from K2M (Leesburg, VA, USA), Medicrea (Lyon, France), Misonix (Farmingdale, NY, USA), International Spine Study Group Foundation (Brighton, CO, USA), Society of Lateral Access Surgery (San Diego, CA, USA), Scoliosis Research Society (Milwaukee, WI, USA), and San Diego Spine Foundation (San Diego, CA, USA). One of the authors certifies that he (RE) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD10,000 from Globus Medical (Audubon, PA, USA), Aesculap/B. Braun (Center Valley, PA, USA), DePuy (West Chester, PA, USA), Johnson & Johnson Company (New Brunswick, NJ, USA), Eli Lilly (Indianapolis, IN, USA), Synthes (West Chester, PA, USA), DiFusion (Georgetown, TX, USA), Inv...

Section: Discussionmentioning

confidence: 99%

Do Longer Surgical Procedures Result in Greater Contamination of Surgeons’ Hands?

Hosseini

Mundis

Eastlack

et al. 2016

“…Orthopaedic SSIs prolong hospital stays by 7 to 14 days per patient [10,31] and increase healthcare costs by more than 300% [31]. The risk factors for an SSI after orthopaedic surgery include older age, other nosocomial infections, wound contamination class, rheumatoid arthritis, the use of a drain, and length of preoperative stay [9,14,24,27]. A prior study identified the elbow and tibia as independently associated with SSI after trauma [4].…”

Section: Introductionmentioning

confidence: 99%

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

Claessen

Braun

Leeuwen

et al. 2016

Background Surgical site infections are one of the more common major complications of elbow fracture surgery and can contribute to other adverse outcomes, prolonged hospital stays, and increased healthcare costs. Questions/purposes We asked: (1) What are the factors associated with a surgical site infection after elbow fracture surgery? (2) When taking the subset of closed elbow fractures only, what are the factors associated with a surgical site infection? (3) What are the common organisms isolated from an elbow infection after open treatment? Methods One thousand three hundred twenty adult patients underwent surgery for an elbow fracture between January 2002 and July 2014 and were included in our study. Forty-eight of 1320 patients (4%) had a surgical site infection develop. Thirty-four of 1113 patients with a closed fracture (3%) had a surgical site infection develop.Results For all elbow fractures, use of plate and screw fixation (adjusted odds ratio [OR]= 2.2; 95% CI, 1.0-4.5; p = 0.041) and use of external fixation before surgery (adjusted OR = 4.7; 95% CI, 1.1-21; p = 0.035) were associated with higher infection rates. When subset analysis was performed for closed fractures, only smoking (adjusted OR = 2.2; 95% CI, 1.1-4.5; p = 0.023) was associated with higher infection rates. Staphylococcus aureus was the most common bacteria cultured (59%). Conclusions The only modifiable risk factor for a surgical site infection after open reduction and internal fixation was cigarette smoking. Plate fixation and temporary external fixation are likely surrogates for more complex injuries, therefore no recommendations should be inferred from this association. Surgeons should counsel patients who smoke. Level of Evidence Level IV, prognostic study.

“…A prospective study encompassing 376 patients undergoing various orthopaedic procedures failed to find operative time to be an independent risk factor for infection with the exception of operative time over 4 hours in spine fusions [116]. In yet another study including 41 patients undergoing spine surgery with infections and 178 noninfected control subjects, operative time was correlated but was not an independent risk factor for infection [91].…”

Section: Operative Time and Postoperative Infectionmentioning

confidence: 98%

“…The orthopaedic literature is equivocal on this subject [37,49,81,116,121,136]. Two retrospective analyses of infections in patients undergoing TKA, one including 100 patients and another 243 patients, reported no correlation between length of surgery and infection [49,121].…”

Section: Operative Time and Postoperative Infectionmentioning

confidence: 99%

Myths and Legends in Orthopaedic Practice: Are We All Guilty?

Tejwani

Immerman

2008

Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices.