Risk Factors for Surgical Site Infections Following Fasciotomy in Patients With Acute Compartment Syndrome: A Study on the February 2023 Kahramanmaraş Earthquake

Abstract

Introduction: Surgical site infections (SSIs) developing after fasciotomy are difficult to treat, costly, and an important source of mortality and morbidity. This study aimed to determine the risk factors affecting the development of SSI in patients who underwent fasciotomy with the diagnosis of acute compartment syndrome (ACS) within 72 hours after two consecutive earthquakes of 7.7 and 7.6 magnitude that occurred in Kahramanmaraş on February 6, 2023. Method: A total of 116 patients were retrospectively analyzed. Patients were divided into two groups: those who developed SSI and those who did not. In this study, variables such as basic demographic characteristics, time of fasciotomy, center performing fasciotomy, type of wound closure, affected extremity, concomitant renal failure, hyperbaric oxygen (HBO) therapy, blood creatine kinase (CK) level were examined. Results: Of 116 patients, 58 (50%) had SSI. It was statistically observed that patients who underwent treatment with vacuum-assisted closure (VAC), those who underwent primary closure with the shoelace method, those who went into renal failure, and those whose fasciotomy was performed in an earthquake zone had a higher incidence of SSI (p<0.001). Blood CK level above 17.839 seemed to be a risk factor according to receiver operating characteristic (ROC) analysis (P<0.01). Age (p=0.193), gender (p=0.125), fasciotomy time (p=0.843), lower extremity (p=0.234), upper extremity (p=0.806), and HBO treatment (p=0.56) were not associated with SSI. Infection was found to be a significant risk factor for amputation (p<0.001). Conclusion: The use of VAC as a wound closure technique for SSI after fasciotomy in patients who developed ACS due to the earthquake, the presence of renal failure in the patients, and performing fasciotomy in the earthquake zone were independent risk factors. A blood CK level above 17.839 was also determined as a risk factor, but the confidence interval was found to be low.

Analysis of wound infections among pediatric patients following the 2023 Türkiye–Syria earthquakes

“…In another study, again similar to ours, exposure to a collapse, fasciotomy, and amputation were more common in patients with WI [ 7 ]. In a study evaluating the risk of SSI in patients with multiple extremity damage or bone fractures, no increase in the risk of infection was found [ 19 ]. We did not find a relationship between the presence of fracture and WI, but WI was more common in cases with damage to multiple extremities.…”

“…In a study evaluating SSIs in patients who underwent fasciotomy due to earthquake injuries, renal insufficiency was found to be associated with infection [ 19 ]. In our study, patients with renal insufficiency were included in the group with crush syndrome and it was found that WI developed more frequently among these patients.…”

“…In our study, patients with renal insufficiency were included in the group with crush syndrome and it was found that WI developed more frequently among these patients. In the aforementioned study, CK values above 17.839 U/L were associated with the development of SSI [ 19 ]. In our study, rhabdomyolysis developed in patients with severe extremity damage, resulting in an increase in CK, ALT, AST, and K values and consequently acute renal failure and crush syndrome.…”

“…In our study, the infection rate was 36.3% (4/11) in patients who underwent fasciotomy. In an evaluation of SSIs after fasciotomy following the 2023 Kahramanmaraş earthquakes, the rate of fasciotomy infection was found to be 50% (58/116) [ 19 ]. Some notes were also compiled regarding empirically initiated treatments in different studies.…”

“…Some notes were also compiled regarding empirically initiated treatments in different studies. In one study, first-generation cephalosporin was used for preoperative fasciotomy prophylaxis and for 3 days postoperatively, and in another study, it was stated that most patients received amoxicillin-clavulanate in empirical treatment [ 19 , 26 ]. The infection rate was found to be higher in those studies.…”