Risk factors for surgical site infection following operative treatment of ankle fractures: A systematic review and meta-analysis

Shao, Jiashen; Zhang, Huixin; Yin, Bing; Li, Jia; Zhu, Yanbin; Zhang, Yingze

doi:10.1016/j.ijsu.2018.06.018

Cited by 76 publications

(73 citation statements)

References 35 publications

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“…Surgery in elderly patients represents an at‐risk procedure in terms of both anaesthetic and surgical plan, and the ASA classification system was a practicable and excellent assessment tool for estimation of the inpatients' physical status and endurance capability to surgery and anaesthesia. The ASA score has been identified as an independent risk factor of postoperative SSI in orthopaedics and other disciplines . In the present study, the ASA classified III‐IV score was associated with quite a high risk of SSI (OR = 2.2).…”

Section: Discussionsupporting

confidence: 49%

Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Dong

Liang

et al. 2019

International Wound Journal

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Geriatric population is increasing rapidly worldwide, and fragility fracture and complication following orthopaedic surgery in elderly people have now become major challenges for surgeons. Further studies are required to identify potentially modifiable factors associated with surgical site infection (SSI) in geriatric patients. This retrospective, multicenter study was conducted at four level I hospitals in China. During the 31-month study period, a total of 2341 patients (65 years or older) underwent orthopaedic surgery and complete data were recorded from September 2015 to April 2018. Demographics information, medications and additional comorbidities, surgery-related variables, and laboratory indexes were extracted and analysed. Receiver-operating characteristic analysis was performed to detect the optimum threshold of continuous variables. Independent risk factors of SSI were identified by univariate and multivariate analyses. Finally, 63 patients suffered from wound infection within the follow-up period, indicating a 2.7% incidence rate of SSI. Statistical results showed that open injury (odds ratio [OR], 9.5; 95% confidence interval [CI], 5.4-16.7), American Society of Anesthesiologists classified III-IV score (OR, 2.2; 95% CI, 1.3-3.8), surgical duration of >132 minutes (OR, 2.9; 95% CI, 1.1-5.0), serum albumin (ALB) of <36.4 mg/L (OR, 2.0; 95% CI, 1.6-3.4), and blood glucose (GLU) of >118 mg/dL (OR, 3.1; 95% CI, 1.1-5.3) were independent risk factors of postoperative SSI. With the application of sensitive and modifiable variables such as surgical duration and the levels of ALB and GLU, more geriatric patients with sub-high risk of postoperative SSI could be identified.

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Section: Discussionsupporting

confidence: 49%

Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Dong

Liang

et al. 2019

International Wound Journal

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“…The gender difference in risk of infection issues has been little consistent across orthopaedic studies, and almost all the studies specified at ankle fractures did not identify the independent association with postoperative SSI 2,7,16,18,22,23 . In this study, we found the 2.69‐fold increased risk of SSI in men.…”

Section: Discussionmentioning

confidence: 48%

“…Meng et al 7 reported the incidence rate of deep SSI was 2.83% in 2617 patients with ankle fracture treated by open reduction and internal fixation (ORIF). Shao et al 18 pooled the data in a meta‐analysis of 8103 ankle fractures by ORIF and found the overall rate of SSI was 7.2%. In contrast, this study included ankle fractures reduced by either open or closed manner, and reported a comparable incidence of 2.9%.…”

Section: Discussionmentioning

confidence: 99%

Multiple preoperative biomarkers are associated with incidence of surgical site infection following surgeries of ankle fractures

Liu

Zhu

Chen

et al. 2020

International Wound Journal

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The aim of the study was to investigate the epidemiologic characteristics of surgical site infection (SSI) following surgeries of ankle fractures. This was a retrospective study. Patients who underwent surgeries for ankle fractures in our hospital between January 2016 and June 2019 were included. Inpatient medical records were inquired for data collection, including demographics, comorbidities, injury‐related data, laboratory biomarkers, and confirmation of the SSI cases. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Among the 1532 patients, 45 had a postoperative SSI, indicating the incidence rate of 2.9%. About 18% of SSIs were identified after discharge. Twenty percent of SSIs were caused by mixed bacteria, and 39% were caused by drug‐resistant bacteria. In the final multivariate model, 7 factors including 5 biomarkers were identified to be independently associated with SSI: gender (male vs female, OR, 2.69; 95% CI, 1.33‐4.76), perioperative blood transfusion (OR. 3.02; 95% CI, 1.30‐7.04), albumin <35 g/L (OR, 2.87; 95% CI, 1.31‐6.31), lower high‐density lipoprotein cholesterol (HDL‐C) (OR, 2.34; 95% CI, 1.19‐4.60), haemoglobin (OR, 2.16; 95% CI, 1.03‐4.67), elevated alanine aminotransferase (OR, 2.09; 95% CI, 1.10‐3.95) and neutrophile/lymphocyte rate (NLR, OR, 3.45; 95% CI, 1.33‐6.74). These epidemiologic data on SSI may help counsel patients about the risk of SSI, individualised assessment of the risk factors, and accordingly the risk stratification.

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“…Often, early hospitalization was associated with the need for additional consultations or examinations. Nevertheless, the duration of stay of patients in the ward before the surgery directly correlates with the risk of infectious complications in the postoperative period, and therefore, admission to the hospital on the eve of the operation should be considered optimal [10].…”

Section: Resultsmentioning

confidence: 99%

Is It Necessary to Perform a Routine Antibiotic Prophylaxis before an Elective Surgery of Cesarean Section?

Belyaev

Nazarenko

Dubrova

et al. 2021

Open Access Maced J Med Sci

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INTRODUCTION: According to the data by World Health Organization, the broad and often insufficiently substantiated prescription of antibiotics, including for prophylactic purposes, has led to the growth of antibiotic-resistant microflora, which is a dangerous and intractable problem of modern medicine. Despite the undoubted benefits of antibiotics in the management of wound infection and endometritis after cesarean section, the routine prophylactic administration of antibacterial drugs can not only carry the risk of growth of resistant nosocomial microflora, but also have doubtful effects on the health of a newborn. PURPOSE OF THE STUDY: The purpose of the study was to justify the possibility of carrying out elective cesarean section operations without routine antibiotic prophylaxis. MATERIALS AND METHODS: An analysis of 333 cases of elective cesarean section operations carried out in the obstetric department in the period from 2017 to 2019 was performed. Routine antibiotic prophylaxis before surgery was not prescribed in 118 healthy patients with an uncomplicated history and a smooth course of the gestational process. The remaining 215 women received a single intravenous injection of 1 g of cefazolin sodium intraoperatively, after extraction of the fetus. A comparative analysis of the clinical groups was carried out according to the following criteria: vaginal microbiocenosis before surgical delivery, duration, and features of the operation, clinical blood count on days 1 and 5 of the post-operative period, condition of postoperative sutures, the presence of discharge from the wound, signs of infectious complications from the uterus or other organs, uterine involution rate, duration of hospital stay before and after surgery, follow-up history for 1 month after discharge from the maternity ward. The data obtained were subjected to statistical processing. RESULTS: We have found no significant differences in the course and number of complications in the postpartum period in the compared clinical groups. The statistically significant transient leukocytosis observed on the 1st day of the postoperative period in patients who did not undergo antibiotic prophylaxis before the surgery seems to be associated with a more pronounced adaptive reaction and was not combined with any clinical symptoms of development of infection. CONCLUSION: No relationship has been identified between the routine prescription of antibiotics before or during an elective cesarean section and the risk of developing infectious complications in the post-operative period. Antibiotic prophylaxis before surgery should be carried out differentially, taking into account the history and features of the course of this pregnancy.

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Risk factors for surgical site infection following operative treatment of ankle fractures: A systematic review and meta-analysis

Cited by 76 publications

References 35 publications

Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Multiple preoperative biomarkers are associated with incidence of surgical site infection following surgeries of ankle fractures

Is It Necessary to Perform a Routine Antibiotic Prophylaxis before an Elective Surgery of Cesarean Section?

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