Risk factors for deep surgical site infection following surgically treated peri-ankle fractures: a case–control study based on propensity score matching

Abstract

Aims This study aims to identify the risk factors for deep surgical site infection (DSSI) following surgically treated peri-ankle fractures. Methods We performed a retrospective case–control study using the propensity score matching (PSM) method in 1:2 ratio, based on the 6 baseline variables, including age, gender, living area, insurance type, fracture location and surgical date. Data on patients who underwent surgical treatment of peri-ankle fractures were collected by inquiring their hospitalization medical records and operative records, as well as the laboratory reports. Conditional logistic regression analysis was performed to identify the risk factors for DSSI. Results A total of 2147 patients were eligibly included and 74 had a DSSI, indicating an incidence rate of 3.4%. After PSM, 70 cases of DSSI and 140 controls without DSSI were matched, constituting the study cohort. The univariate analyses showed significant differences between groups in terms of history of any surgery, time to operation, surgical wound classification, smoking, alcohol drinking, RBC count, hemoglobin concentration and hematocrit (%). The conditional logistic regression analysis showed time to operation of < 4 or > 9 (vs 4–9 days); unclean wound, current smoking, high-energy injury mechanism and lower hematocrit were independent risk factors for DSSI. Conclusions Timely modification of smoking and hematocrit (%), and limiting operation within a rational time frame for an optimized soft tissue condition, may provide potential clinical benefits for SSI prevention.

Study on the risk factors of postoperative wound complications in patients with ankle fracture

“…Some scholars believe that advanced age is a risk factor for wound complications, 22 diabetes is a recognised risk factor for infection 23 . Previous studies have also shown that injury mechanism, open fracture and wound classification are also risk factors for wound complications after ankle fracture 21,24,25 . In this study, we identified nine independent risk factors associated with an increased risk of postoperative wound complications in patients with ankle fracture.…”

“… 23 Previous studies have also shown that injury mechanism, open fracture and wound classification are also risk factors for wound complications after ankle fracture. 21 , 24 , 25 In this study, we identified nine independent risk factors associated with an increased risk of postoperative wound complications in patients with ankle fracture. Including age ≥60 years old OR3.671 (1.875–5.937), complicated with diabetes OR 2.763 (1.236–4.852), BMI OR1.198 (1.143–1.324), current smoking OR2.727 (1.251–5.602), alcoholism OR1.143 (1.034–1.267), injury mechanism (high vs. low and medium energy) OR2.437 (1.238–4.786), open fracture OR1.943 (1.826–2.139), wound classification (II vs.…”

Can appropriate surgical wound management prevent surgical site infection after malleolar fracture surgery?

“…In this study, the incidence of surgical wound healing failure after malleolar fracture surgery was 19%, which is higher than the range of 3.3-6.8% previously reported. However, there were no cases of deep SSI, which have been reported to occur in 1.44-16% of cases in past studies [11][12][13][14].…”

Risk factors contributing to postoperative surgical site infections in patients undergoing ankle fracture fixation: A systematic review and meta‐analysis

“…Smoking, age and alcohol consumption were also identified as significant risk factors. Smoking impairs tissue oxygenation and healing, while aging is often associated with diminished physiological reserves and comorbidities, both of which can compromise postoperative recovery 27 . Alcohol consumption can impair immune function and wound healing, further increasing SSI risk.…”

“…Smoking impairs tissue oxygenation and healing, while aging is often associated with diminished physiological reserves and comorbidities, both of which can compromise postoperative recovery. 27 Alcohol consumption can impair immune function and wound healing, further increasing SSI risk. An elevated ASA score indicates more severe systemic disease, which can compromise a patient's ability to recover from surgery and resist infection.…”