Rascoe Alexander S, Kavanagh Michael D, Audet Megan A, Hu Emily, Vallier Heather A
MetroHealth Medical Center, Cleveland, Ohio, affiliated with Case Western Reserve University.
OTA Int. 2020 May 6;3(2):e077. doi: 10.1097/OI9.0000000000000077. eCollection 2020 Jun.
To identify comorbidities and injury characteristics associated with surgical site infection (SSI) following internal fixation of malleolar fractures in an urban level 1 trauma setting.
Retrospective.
Level 1 trauma center.
PATIENTS/PARTICIPANTS: Seven-hundred seventy-six consecutive patients with operatively managed malleolar fractures from 2006 to 2016.
Open reduction internal fixation.
Superficial SSI (erythema and drainage treated with oral antibiotics and wound care) or deep SSI (treated with surgical debridement and antibiotics).
Fifty-six (7.2%) patients developed SSI, with 17 (30%) of these being deep infections. An a-priori power analysis of n = 325 (α=0.05, β=0.2) was tabulated for differences in univariate analysis. Univariate analysis identified categorical associations ( < .05) between SSI and diabetes mellitus, drug abuse, open fracture, and renal disease but not tobacco abuse, body mass index, or neuropathy. Multivariate logistic regression identified categorical associations between diabetes (OR = 2.2, 95% CI: 1.1-4.3), drug abuse (OR = 3.9, 95% CI: 1.2-12.7), open fracture (OR = 4.1, 95% CI: 1.3-12.8), and renal disease (OR = 2.7, 95% CI: 1.4-5.0) and any (superficial or deep) SSI. A separate multivariate logistic regression analysis found categorical associations between deep SSI requiring reoperation and diabetes (OR = 4.4, 95% CI: 1.6-12.2) and open fracture (OR = 4.1, 95% CI: 1.3-12.8). Furthermore, American society of anesthesiologists classification (ASA) Class 4 patients were (OR = 9.2, 95% CI: 2.0-41.79) more likely to experience an SSI than ASA Class 1 patients.
Factors associated with SSI following malleolar fracture surgery in a single urban level 1 trauma center included diabetes, drug abuse, renal disease, and open fracture. The presence of diabetes or open type fractures were associated with deep SSI requiring reoperation.
Level 3 prognostic: retrospective cohort study.
确定在城市一级创伤中心进行踝关节骨折内固定术后与手术部位感染（SSI）相关的合并症和损伤特征。
回顾性研究。
一级创伤中心。
患者/参与者：2006年至2016年连续776例接受手术治疗的踝关节骨折患者。
切开复位内固定术。
表浅SSI（用口服抗生素和伤口护理治疗的红斑和引流）或深部SSI（用手术清创和抗生素治疗）。
56例（7.2%）患者发生SSI，其中17例（30%）为深部感染。对n = 325（α = 0.05，β = 0.2）进行了先验功效分析，以列出单因素分析中的差异。单因素分析确定了SSI与糖尿病、药物滥用、开放性骨折和肾病之间的分类关联（<0.05），但与烟草滥用、体重指数或神经病变无关。多因素逻辑回归确定了糖尿病（OR = 2.2，95%CI：1.1 - 4.3）、药物滥用（OR = 3.9，95%CI：1.2 - 12.7）、开放性骨折（OR = 4.1，95%CI：1.3 - 12.8）和肾病（OR = 2.7，95%CI：1.4 - 5.0）与任何（表浅或深部）SSI之间的分类关联。另一项多因素逻辑回归分析发现，需要再次手术的深部SSI与糖尿病（OR = 4.4，95%CI：1.6 - 12.2）和开放性骨折（OR = 4.1，95%CI：1.3 - 12.8）之间存在分类关联。此外，美国麻醉医师协会分级（ASA）4级患者发生SSI的可能性比ASA 1级患者高（OR = 9.2，95%CI：2.0 - 41.79）。
在一个城市一级创伤中心，踝关节骨折手术后与SSI相关的因素包括糖尿病、药物滥用、肾病和开放性骨折。糖尿病或开放性骨折的存在与需要再次手术的深部SSI相关。
3级预后性：回顾性队列研究。
