Surgical Wound Classification and Surgical Site Infections in the Orthopaedic Patient.

INTRODUCTION

The Centers for Disease Control and Prevention created a surgical wound classification system (SWC: I, clean; II, clean/contaminated; III, contaminated; and IV, dirty) to preemptively identify patients at risk of surgical site infection (SSI). The validity of this system is yet to be demonstrated in orthopaedic surgery. We hypothesize a poor association between the SWC and the rate of subsequent SSI in orthopaedic trauma cases.

METHODS

Nine hundred fifty-six orthopaedic cases were reviewed. Wounds were risk stratified intraoperatively using the SWC grades (I-IV). SSI was diagnosed clinically or with objective markers. The SWC was compared with SSI rates using a Fisher exact test. Significance was set at < 0.05.

RESULTS

Four hundred patients met the selection criteria. The rate of infection was not significantly different across the SWC grades ( = 0.270). There was a significantly higher risk of SSI among patients with diabetes ( = 0.028).

CONCLUSIONS

The Centers for Disease Control and Prevention SWC showed poor utility in predicting and risk stratifying postoperative SSIs in orthopaedic surgical cases.