Cho Elizabeth, House Hanna, Marten Andrew, Feffer Marina, Agel Julie, Scolaro John, Marmor Meir, Levack Ashley E
Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL.
Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
OTA Int. 2025 Jan 17;8(1):e357. doi: 10.1097/OI9.0000000000000357. eCollection 2025 Mar.
The purpose of this investigation was to evaluate the utility of the Centers for Disease Control (CDC) Surgical Wound Classification (SWC) in predicting surgical site infection (SSI) after orthopaedic trauma procedures.
Retrospective cohort study.
Level I academic trauma center.
PATIENTS/PARTICIPANTS: Adult patients with operatively treated fractures of the leg, ankle, and hindfoot between 2007 and 2022.
N/A.
Presence of SSI was determined by selective chart review of patients who met the screening variables for repeated procedures, open fracture, abscess or wound debridement, intraoperative cultures, or infectious disease consultation (n = 551).
Two thousand seven hundred ninety-one fractures among 2780 patients (n = 11 with bilateral fractures) were included. The overall infection rate was 2.3% (n = 63), and SWC was significantly associated with infection rates (I/clean: 1.0%, II/clean-contaminated: 3.4%, III/contaminated: 6.2%, IV/dirty: 9.8%, < 0.001). When compared with Class I, Classes II through IV had increased odds of infection (odds ratio [OR] II: 3.5, = 0.012; OR III: 6.8, < 0.001; OR IV: 11.0, < 0.001). Subgroup analysis of Classes II and III demonstrated no difference in odds of infection. When stratifying open versus closed fractures, there was no statistical association between CDC SWC and odds of infection.
The CDC SWC has notable limitations for patients with orthopaedic trauma, with ambiguity of classification assignment and decreased discriminatory ability within the central classes. While overall SWC is associated with infection, the relationship seems to be confounded by the effect of open versus closed fractures. Alternative classification systems may have improved utility for stratifying risk in orthopaedic patients.
III.
本研究旨在评估疾病控制中心（CDC）手术伤口分类（SWC）在预测骨科创伤手术后手术部位感染（SSI）方面的效用。
回顾性队列研究。
一级学术创伤中心。
患者/参与者：2007年至2022年间接受手术治疗的腿部、踝部和后足骨折的成年患者。
无。
通过对符合重复手术、开放性骨折、脓肿或伤口清创、术中培养或传染病会诊筛查变量的患者进行选择性病历审查来确定是否存在SSI（n = 551）。
纳入了2780例患者（其中11例为双侧骨折）的2791处骨折。总体感染率为2.3%（n = 63），SWC与感染率显著相关（I/清洁：1.0%，II/清洁-污染：3.4%，III/污染：6.2%，IV/脏污：9.8%，P < 0.001）。与I类相比，II至IV类感染几率增加（比值比[OR] II：3.5，P = 0.012；OR III：6.8，P < 0.001；OR IV：11.0，P < 0.001）。II类和III类的亚组分析显示感染几率无差异。在对开放性骨折与闭合性骨折进行分层时，CDC SWC与感染几率之间无统计学关联。
CDC SWC在骨科创伤患者中存在显著局限性，分类赋值存在模糊性，且中间类别内的鉴别能力下降。虽然总体上SWC与感染有关，但这种关系似乎因开放性骨折与闭合性骨折的影响而混淆。替代分类系统可能在分层骨科患者风险方面具有更好的效用。
III级。
