Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
Department of the Orthopaedics, The Second People' Hospital of Hengshui, Hengshui, Hebei, 053000, PR China.
Int J Surg. 2017 Dec;48:86-91. doi: 10.1016/j.ijsu.2017.10.002. Epub 2017 Oct 16.
Identification of risk factors for surgical site infection (SSI) after surgical ankle fractures was important, but related evidence was inadequate. This study was conducted to investigate the incidence and risk factors for SSI after open reduction and internal fixation (ORIF) of a closed ankle fractures.
Patients who underwent ORIF for a closed ankle fractures at 3 centers between July 2015 and January 2017 were included. Electronic medical recordings (EMR) and Picture Archiving and Communication Systems (PACS) were inquired for information on patients' clinical and radiographic characteristics. The potential factors include 4 aspects: demographics, injury-related, surgery-related and biochemical indictors. Factors related with SSI were analyzed by univariate and further by multivariate logistic regression model.
During the hospitalization, 3.7% (46/1247) of patients developed SSI, with 1.12% (14/1247) for deep and 2.57% (32/1247) for superficial SSI. Approximately half of SSIs were caused by Methicillin-resistant Staphylococcus aureus (MRSA). After adjustment for confounding factors, higher body mass index (BMI), surgeon level (residents or treating surgeon), surgical duration>130mins, delayed surgery, preoperative TP < 60 g/L were significant risk factor or predictors for SSI occurrence.
After comprehensive evaluation of patients medical conditions, immediate operation by a surgeon with more expertise could effectively reduce SSI occurrence.
识别手术部位感染（SSI）的风险因素对于手术踝关节骨折后非常重要，但相关证据不足。本研究旨在探讨闭合性踝关节骨折切开复位内固定（ORIF）后 SSI 的发生率和危险因素。
纳入 2015 年 7 月至 2017 年 1 月期间在 3 个中心接受 ORIF 治疗的闭合性踝关节骨折患者。查询电子病历（EMR）和图片存档与通信系统（PACS）以获取患者临床和影像学特征的信息。潜在因素包括 4 个方面：人口统计学、损伤相关、手术相关和生化指标。采用单因素和进一步多因素逻辑回归模型分析与 SSI 相关的因素。
住院期间，3.7%（46/1247）的患者发生 SSI，其中深部感染 1.12%（14/1247），浅部感染 2.57%（32/1247）。大约一半的 SSI 是由耐甲氧西林金黄色葡萄球菌（MRSA）引起的。调整混杂因素后，较高的体重指数（BMI）、术者级别（住院医师或主治医生）、手术时间>130 分钟、延迟手术、术前总蛋白（TP）<60g/L 是 SSI 发生的显著危险因素或预测因素。
综合评估患者的身体状况后，由经验更丰富的外科医生立即进行手术可有效降低 SSI 的发生。
