Risk Factors for Wound Complications After Ankle Fracture Surgery

Miller, Adam G.; Margules, Andrew; Raikin, Steven M.

doi:10.2106/jbjs.k.01088

Cited by 197 publications

(181 citation statements)

References 21 publications

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“…The reasons for postponing the surgical repair were not recorded. In our study it was the policy to plan the fractures electively and to wait for approximately one week to let the swelling settle, which is not uncommon practice [22]. In some cases a conservative treatment was initiated, but because of secondary dislocation a change to surgery was made.…”

Section: Discussionmentioning

confidence: 97%

The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature

Schepers

Vries

Lieshout

et al. 2013

International Orthopaedics (SICOT)

137

105

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Purpose Information about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early surgery lowers the rate of infectious wound complications. Secondly we looked at the influence of surgical delay and complications on patient reported functional outcome. Methods All consecutive, closed distal fibular fractures treated surgically with a plate were included and retrospectively analysed for the delay in operation and wound complications. In a second cohort of patients with a AO-Weber Btype ankle fracture outcome was measured using the OlerudMolander ankle score (OMAS), the American Orthopaedic Foot and Ankle Society score (AOFAS) and a visual analog score (VAS) for overall satisfaction. Results Patients treated within one day experienced no wound complications (zero out of 60), whereas in the delayed group 11 % (16/145) did (p=0.004). A similar significant difference was found for the patients treated within one week (2/98) versus after one week (14/107). A systematic review of the literature showed a difference in wound complications of 3.6 % (early) versus 12.9 % (late) (p<0.0001). After 43 months, the median AOFAS was 11.5 points lower in the complication group, the OMAS 10 points, and the VAS 0.5 points, with all differences being statistically significant. Conclusions Every effort should be made to operate on closed ankle fractures as soon as reasonably possible. A delay in surgery is associated with a significant rise in infectious wound complications, which significantly lowers outcome and patient satisfaction. These fractures should preferably be treated within the first day.

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Section: Discussionmentioning

confidence: 97%

The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature

Schepers

Vries

Lieshout

et al. 2013

International Orthopaedics (SICOT)

137

105

View full text Add to dashboard Cite

show abstract

“…Higher CCI scores were found to significantly increase the risk of infection at 10 years after spine surgery (hazard ratio, 2.48; 95% CI, 1.93-3.19) [17]. Some comorbidities, in particular diabetes, have an important influence on infections after orthopaedic trauma surgery [8,22].…”

Section: Discussionmentioning

confidence: 99%

“…In orthopaedic surgery, comorbidities have been identified as predictors of mortality after arthroplasty, trauma surgery, and oncologic surgery [4,9,18,20,21,25,27,36]. Complications after ankle fractures, spinal metastasis surgery, and knee or hip arthroplasty also are associated with comorbidities [2,12,[31][32][33][34] as are infections after orthopaedic trauma, spine surgery, knee or hip arthroplasty [8,17,22,36], and transfusion after knee or shoulder arthroplasty [12,29].…”

Section: Introductionmentioning

confidence: 99%

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Voskuijl

Hageman

Ring

2014

Clinical Orthopaedics &Amp; Related Research

173

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Background The Charlson Comorbidity Index (CCI) originally was developed to predict mortality within 1 year of hospital admission in patients without trauma. As it includes factors associated with medical and surgical complexities, it also may be useful as a predictive tool for hospital readmission after orthopaedic surgery, but to our knowledge, this has not been studied. Questions/purposes We asked whether an increased score on the CCI was associated with (1) readmission, (2) an increased risk of surgical site infection or other adverse events, (3) transfusion risk, or (4) mortality after orthopaedic surgery. Methods A total of 30,129 orthopaedic surgeries performed between 2008 and 2011 without any orthopaedic surgery in the preceding 30 days were analyzed. International Classification of Diseases, 9 th Revision codes were used to identify diagnoses, procedures, surgery-related adverse events, surgical site infection, and comorbidities as listed in the updated and reweighted CCI. A total of 913 patients (3.0%) were readmitted within 30 days after discharge; in 393 (1.4%) patients adverse events occurred; 417 patients (1.4%) had a surgical site infection develop; 211 (0.7%) needed transfusions, and 56 (0.2%) died within 30 days after surgery. Ordinary least squares regression analyses were used to determine whether the CCI was associated with these outcomes. Results The CCI accounted for 10% of the variation in readmissions. Every point increase in CCI score added an additional 0.45% risk in readmission for patients undergoing arthroplasty, 0.63% for patients undergoing trauma surgery, and 0.9% risk for patients undergoing spine surgery (all p \ 0.01). The CCI was not associated with surgical site infection or other adverse events, but accounted for 8% of the variation in transfusion rate and 10% of the variation in mortality within 30 days of surgery. Conclusions The CCI can be used to estimate the risk of readmission after arthroplasty, hand and upper extremity surgery, spine surgery, and trauma surgery. It also can be used to estimate the risk of transfusion after arthroplasty, spine, trauma, and oncologic orthopaedic surgery and the risk of mortality after shoulder, trauma, and oncologic orthopaedic surgery.

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“…Costigan et al [17] reported infection in 83% of patients with diabetes lacking preoperative pedal pulses and 92% with peripheral neuropathy after surgical treatment for ankle fractures. Numerous studies have supported associations with increased wound complications and surgical site infections in patients with complicated diabetes, peripheral vascular disease, and wound compromising medications [8,16,23,36,43,44,59]. Other comorbidities associated with increased risk of postoperative infection include obesity, malnutrition, tobacco use, and immunosuppressive medication [11,21,43,45].…”

Section: Discussionmentioning

confidence: 99%

What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

Ruta

Kadakia

Irwin

2014

Clinical Orthopaedics &Amp; Related Research

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Risk Factors for Wound Complications After Ankle Fracture Surgery

Cited by 197 publications

References 21 publications

The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature

The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

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