Relationship between surgeon volume and the risk of deep surgical site infection (DSSI) following open reduction and internal fixation of displaced intra‐articular calcaneal fracture

Abstract

It is well established that the postoperative results were affected by the surgeon volume in a variety of elective and emergent orthopaedic surgeries; however, by far, no evidences have been available as for surgically treated displaced intra‐articular calcaneal fractures (DIACFs). We aimed at investigating the relationship between surgeon volume and deep surgical site infection (DSSI) following open reduction and internal fixation (ORIF) of DIACFs. This was a further analysis of prospectively collected data from a validated database. Patients with DIACFs stabilised by ORIF between 2016 and 2019 were identified. Surgeon volume was defined as the number of surgically treated calcaneal fractures within one calendar year and was dichotomised based on the optimal cut‐off value. The outcome measure was DSSI within 1 year postoperatively. Multivariate logistics regression analyses were performed to examine the relationship, adjusting for confounders. Among 883 patients, 19 (2.2%) were found to have a DSSI. The DSSI incidence was 6.5% in surgeons with a low volume (<6/year), 5.5 times as that in those with a high volume (≥6/year) (incidence rate, 1.2%; P < 0.001). The multivariate analyses showed a low volume <6/year was associated with a 5.8‐fold increased risk of DSSI (95% confidence interval, 2.2‐16.5, P < 0.001). This value slightly increased after multiple sensitivity analyses, with statistical significances still unchanged (OR range, 6.6‐6.9; P ≤ 0.001). The inverse relationship indicates a need for at least six cases/year for a surgeon to substantially reduce the DSSIs following the ORIF of DIACFs.

Surgeon volume and risk of deep surgical site infection following open reduction and internal fixation of closed ankle fracture

“…Specified at foot and ankle trauma, Poeze et al 13 found the yearly institutional volume of <10 cases were associated with an increased 24‐fold risk of deep infection following surgeries of calcaneal fractures; Stewart et al 12 found each 5 additional surgeries per year reduced complications by 9% when specified at repair of tarsal fractures. Similarly, in a most recent study, Qin et al 14 found the low‐volume (<6/year) of ORIF procedures for calcaneal fracture was associated with a 5.5‐time risk of deep infection. These findings available highlighted the importance of the centralised surgical treatment for specific locations of fracture and helped increase the awareness about of benefits of the shift of operative to an experienced surgeon.…”

Prevalence of surgical site infection and risk factors in patients after knee surgery: A systematic review and meta‐analysis

“…Conversely, a deep SSI is an infection that surpasses the surface layers of the surgical wound and infiltrates deeper into the body. It may encompass structures such as muscles, fascia, or in certain cases, joints and bones, contingent upon the specific surgical procedure 9–11 …”

“…It may encompass structures such as muscles, fascia, or in certain cases, joints and bones, contingent upon the specific surgical procedure. [9][10][11] SSI is recognized as a preventable complication in orthopaedic surgeries. Recent guidelines have emphasized the importance of reducing this costly and preventable complication.…”

The Protein Profiles of Local Tissue Postoperative Incision Infection After Plate Internal Fixation of Calcaneal Fractures

“…With the development of medical treatments, the fracture internal fixation has become an important therapy for calcaneal fractures [3]. However, the local tissue infection near the surgical site which comprises one of the common frequent complications (0.5%-2.5%) following a calcaneal fracture operation, involving deep structures such as bone, deep fascia and implants, which may eventually lead to the formation of infection biofilms, osteomyelitis, scar formation and even the need to remove the internal fixation [4,5]. The causes of the infection are complicated and to detect the infection on time is important for the surgeons to make decisions for further treatment [5].…”