Open Fixation After Preperitoneal Pelvic Packing Is Associated With a High Surgical Site Infection Rate

Abstract

Objectives: To evaluate the incidence of pelvic space surgical site infection (SSI) after preperitoneal pelvic packing (PPP) for persistent hemodynamic instability. Design: Retrospective comparative study. Setting: Urban Level 1 trauma center. Patients/Participants: 83 patients who received PPP and 55 patients who had open reduction and internal fixation (ORIF) of the anterior pelvic ring without PPP. Intervention: Operative fixation. Main Outcome Measurements: Pelvic space SSI. Results: The SSI rate in the PPP group was 31.3% (26/83) compared with 10.9% (6/55) in the control group (proportional difference 20.4%, confidence interval (CI) 6.4–32.5, P = 0.007). Patients in the PPP group (n = 43) were 1:1 propensity score matched with patients in the control group to account for differences in Injury Severity Score and American Society of Anesthesiologists score. In this matched cohort, the rate of pelvic space SSI remained higher in the PPP group compared with that in the control group (30.2% vs. 9.3%; proportional difference 20.9%, CI, 3.7–36.3; P = 0.02). On multivariate analysis of the PPP group, anterior ORIF (odds ratio 6.56, CI, 2.00–21.47, P = 0.002) was found to be independently associated with SSI. Conclusions: PPP is an independent risk factor of space SSI. The likelihood of SSI after PPP is increased with anterior ORIF. The morbidity of SSI after PPP must be weighed against the risk of exsanguination. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.