Tausendfreund Jasper, Penning Diederick, Naryapragi M Azad, Reisinger Kostan W, Tanis E, Joosse P, Schepers T
Department of Trauma Surgery, Noordwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands.
Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
Arch Orthop Trauma Surg. 2025 Jan 23;145(1):135. doi: 10.1007/s00402-024-05623-9.
Surgical site infections (SSI) are one of the more severe complications following ankle surgery. It is associated with worse outcomes and re-admissions. Therefore, identification of risk factors is essential. The aim of this study was to identify risk factors for SSI in patients undergoing surgery for ankle fractures.
A retrospective study was performed in a large cohort (n = 929) of patients who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2015 and 2020 in the Netherlands. The primary outcome variables included rate of SSI (superficial or deep) and deep SSI. Prediction factors were categorized as patient-related, injury-related and treatment-related.
The incidence rate was 9.36% for SSI and 3.55% for deep SSI. Univariate analysis showed significant associations for higher age (p < 0.001), DM (p = 0.018), ASA 2 and 3 (p = 0.013 and p < 0.001), bi- and trimalleolar fractures (p = 0.021 and p = 0.013), open fractures (p = 0.004) and small size plate compared to screw fixation (p = 0.027). The only independent significant risk factor for SSI in multivariate analysis was open fracture. For deep SSI the significant risk factors were DM (p = 0.039), ASA 3 and 4 (p = 0.001 and p = 0.005) and open fracture (p = 0.002). After multivariate analysis, the independent significant risk factors were open fracture and ASA 3 and 4.
Higher age, DM, ASA 2 and 3, bi- and trimalleolar fractures, open fractures and standard plate-size implant placement were identified as significant risk factors for SSI. Open fracture was the only significant independent risk factor for SSI after ORIF of ankle fractures. In deep SSI, there were different risk factors. DM, ASA 3 and 4, and open fractures were significantly associated. Although, open fracture and ASA 3 and 4 were the significant independent risk factors.
手术部位感染（SSI）是踝关节手术后较为严重的并发症之一。它与更差的预后和再次入院相关。因此，识别风险因素至关重要。本研究的目的是确定踝关节骨折手术患者发生SSI的风险因素。
对2015年至2020年在荷兰接受踝关节骨折切开复位内固定术（ORIF）的一大群患者（n = 929）进行了回顾性研究。主要结局变量包括SSI（浅表或深部）发生率和深部SSI。预测因素分为与患者相关、与损伤相关和与治疗相关。
SSI发生率为9.36%，深部SSI发生率为3.55%。单因素分析显示，年龄较大（p < 0.001）、糖尿病（DM，p = 0.018）、美国麻醉医师协会（ASA）分级为2和3（p = 0.013和p < 0.001）、双踝和三踝骨折（p = 0.021和p = 0.013）、开放性骨折（p = 0.004）以及与螺钉固定相比使用小尺寸钢板（p = 0.027）之间存在显著关联。多因素分析中，SSI唯一独立的显著风险因素是开放性骨折。对于深部SSI，显著风险因素为DM（p = 0.039）、ASA分级为3和4（p = 0.001和p = 0.005）以及开放性骨折（p = 0.002）。多因素分析后，独立的显著风险因素是开放性骨折以及ASA分级为3和4。
年龄较大、DM、ASA分级为2和3、双踝和三踝骨折、开放性骨折以及标准尺寸钢板植入被确定为SSI的显著风险因素。开放性骨折是踝关节骨折ORIF术后SSI唯一显著的独立风险因素。在深部SSI中，存在不同的风险因素。DM、ASA分级为3和4以及开放性骨折显著相关。尽管如此，开放性骨折以及ASA分级为3和4是显著的独立风险因素。
