What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

Abstract

Background Surgical site infections are one of the more common major complications of elbow fracture surgery and can contribute to other adverse outcomes, prolonged hospital stays, and increased healthcare costs. Questions/purposes We asked: (1) What are the factors associated with a surgical site infection after elbow fracture surgery? (2) When taking the subset of closed elbow fractures only, what are the factors associated with a surgical site infection? (3) What are the common organisms isolated from an elbow infection after open treatment? Methods One thousand three hundred twenty adult patients underwent surgery for an elbow fracture between January 2002 and July 2014 and were included in our study. Forty-eight of 1320 patients (4%) had a surgical site infection develop. Thirty-four of 1113 patients with a closed fracture (3%) had a surgical site infection develop.Results For all elbow fractures, use of plate and screw fixation (adjusted odds ratio [OR]= 2.2; 95% CI, 1.0-4.5; p = 0.041) and use of external fixation before surgery (adjusted OR = 4.7; 95% CI, 1.1-21; p = 0.035) were associated with higher infection rates. When subset analysis was performed for closed fractures, only smoking (adjusted OR = 2.2; 95% CI, 1.1-4.5; p = 0.023) was associated with higher infection rates. Staphylococcus aureus was the most common bacteria cultured (59%). Conclusions The only modifiable risk factor for a surgical site infection after open reduction and internal fixation was cigarette smoking. Plate fixation and temporary external fixation are likely surrogates for more complex injuries, therefore no recommendations should be inferred from this association. Surgeons should counsel patients who smoke. Level of Evidence Level IV, prognostic study.

Cessation from Smoking Improves Innate Host Defense and Clearance of Experimentally Inoculated Nasal Staphylococcus aureus

“…4). These findings correspond with smokers' enhanced susceptibility to clinical S. aureus infections and postoperative S. aureus-mediated complications (28,33). Combined with the observation that month-long carriers of experimentally inoculated S. aureus also presented higher natural nasal S. aureus loads (Fig.…”

“…Some studies associated smoking and secondhand smoke with increased S. aureus carriage rates (20)(21)(22)(23), and others declared no association (24,25), while the Tromsø (Norway) Staph and Skin Study 2007-08 indicated that smoking might be protective (26). Notably, S. aureus carriage triples the risk for postoperative skin and soft tissue infections (27), and smoking associates with higher infection rates (28). In the current study, we determined the nasal S. aureus carriage rate in healthy smokers who attend the University of Central Florida (UCF).…”

Infection after fracture fixation: Current surgical and microbiological concepts

“…The problem becomes clear when reviewing the clinical literature. Some studies have cited the CDC-guidelines without a specific description of osteomyelitis [19,20]; others use these guidelines but include their own additional inclusion criteria such as purulent drainage or other clinical signs [21]. Perhaps due to the lack of suitable definitions for trauma patients, there are also authors who do not define infection [22] and others who provide a unique custom-made definition [23].…”

Future Directions to Limit Surgical Site Infections

“…Cigarette smoking has a negative impact on wound healing in orthopedic surgery with an increase in the incidence of SSI of 7% [4]. Many authors have also confirmed an increase in SSI after plastic surgery using multivariate analysis and shown that smoking suppresses the immune system [5]. Numerous studies have confirmed it as a complication for wound healing in terms of necrosis and infections due to the vasoconstricting and deoxygenating effects of nicotine and other tobacco-related chemicals.…”