Schade Meredith A, Hollenbeak Christopher S
Department of Infectious Disease, Penn State Milton S. Hershey Medical Center (MAS) Hershey, Pennsylvania.
Departments of Surgery and Public Health Sciences, Penn State College of Medicine (CSH) Hershey, Pennsylvania.
Foot Ankle Spec. 2018 Aug;11(4):335-341. doi: 10.1177/1938640017735887. Epub 2017 Oct 13.
Early postoperative infection (EPI) following hardware placement in patients with malleolar fractures is a serious complication. Identifying factors that place patients at risk for early infection may help target interventions to prevent infections.
Data for the study included all adult patients who underwent operative management for closed malleolar fracture from 2006 to 2013 in the National Surgical Quality Improvement Program database. Characteristics of patients with and without EPI were compared using univariate tests. Logistic regression was used to perform a multivariable analysis of risk factors for EPI while controlling for covariates. Length of stay was analyzed using a generalized linear model.
The analysis sample included 7054 patients, of whom 116 developed EPI. Patients with EPI were slightly older on average, more likely to have diabetes, and had higher anesthesia class. Multivariable analysis identified several risk factors for EPI, including diabetes (odds ratio [OR] = 2.6; 95% CI = 1.5-4.5; P < .0001), American Society of Anaesthesiology (ASA) class 3+ (OR = 2.3; 95% CI = 1.03-5.0; P = .04), unclean surgery (OR = 2.4; 95% CI = 1.3-4.2; P < .0001), and inpatient location (OR 1.7, 1.1-2.7; P = .01). After controlling for other factors, EPI was not significantly associated with a longer hospital stay (0.2 days, P = .55).
In the 30 days after hardware placement for malleolar fracture, infection occurs with increased frequency in older patients, diabetics, those with higher anesthesia class, and in the setting of unclean surgery and inpatient operative location. Patients with the identified risk factors should be followed closely for development of infection.
Level III: Retrospective cohort study.
踝关节骨折患者内固定术后早期感染（EPI）是一种严重的并发症。识别使患者面临早期感染风险的因素可能有助于确定预防感染的干预措施。
该研究的数据包括2006年至2013年在国家外科质量改进计划数据库中接受闭合性踝关节骨折手术治疗的所有成年患者。采用单因素检验比较有和没有EPI的患者的特征。在控制协变量的同时，使用逻辑回归对EPI的危险因素进行多变量分析。使用广义线性模型分析住院时间。
分析样本包括7054例患者，其中116例发生EPI。发生EPI的患者平均年龄稍大，更有可能患有糖尿病，且麻醉分级较高。多变量分析确定了几个EPI的危险因素，包括糖尿病（比值比[OR]=2.6；95%可信区间[CI]=1.5-4.5；P<.0001）、美国麻醉医师协会（ASA）3级及以上（OR=2.3；95%CI=1.03-5.0；P=.04）、手术不清洁（OR=2.4；95%CI=1.3-4.2；P<.0001）和住院地点（OR 1.7，1.1-2.7；P=.01）。在控制其他因素后，EPI与住院时间延长无显著相关性（0.2天，P=.55）。
在踝关节骨折内固定术后30天内，老年患者、糖尿病患者、麻醉分级较高的患者以及在手术不清洁和住院手术地点的情况下感染发生率增加。应密切关注具有已确定危险因素的患者是否发生感染。
III级：回顾性队列研究。
