Elsevier

Injury

Volume 41, Issue 4, April 2010, Pages 396-399
Injury

Postoperative surgical site infection following acetabular fracture fixation

https://doi.org/10.1016/j.injury.2009.11.005Get rights and content

Abstract

Postoperative surgical site infection (SSI) in orthopaedic trauma surgery is uncommon, but can present serious complications. This study was designed to assess the prevalence of, and to identify the risk factors for, SSI following acetabular fracture open reduction and internal fixation. A total of 326 consecutive patients who underwent acetabular fracture surgery were retrospectively reviewed. There were 17 patients (5.2%) who developed a SSI, including 10 deep infections and 7 superficial infections. Staphylococcus aureus was the most common causative pathogens in 9 patients, and was Methicillin-resistant in 3 patients. Enterococcus faecalis was found in 6 patients, Staphylococcus epidermidis in 3 patients, and Pseudomonas aeruginosa and enterbacter cloacae in 2 patients each. Fourteen of 17 patients developed their infection within 4 weeks after the fixation. Univariate analysis demonstrated that the SSI group had statistically significant higher Injury Severity Score, longer intensive care unit (ICU) stays, larger amount of packed red blood cells transfused, longer operative time, larger estimated operative blood loss, higher body mass index (BMI), more frequent performance of combined approach, embolisation of internal iliac arteries, association of urinary tract injury, and Morel-Lavallée lesion compared to the no SSI group. Multivariate analysis using these 10 parameters showed that BMI, ICU stay, and Morel-Lavallée lesion were independently significant risk factors for SSI. To reduce the incidence of SSI following acetabular fracture surgery, special attention should be directed at the care of obese patients, patients requiring ICU care, and patients with associated Morel-Lavallée lesions.

Introduction

Postoperative surgical site infection (SSI) in orthopaedic trauma surgery is uncommon.4, 5, 8, 9, 19, 21, 25, 28 However, if infection occurs, patient outcome is significantly affected with potentially devastating sequelae. SSI complications lead to an increased number of operations, poorer healing rates, and decreased functional and psychological outcomes. SSI also results in prolongation of the total hospital stay by a median of 2 weeks, doubling of re-hospitalisation rates, and an increase in health-care costs by more than 300%.5, 27 A wide variety of risk factors for SSI after orthopaedic surgery have been reported. Patient-related risk factors for SSI in orthopaedic surgery include diabetes, obesity, smoking, older age, steroid-use, and other specific disease relevant to immunocompromised status.4, 9, 10, 21, 22, 25 Surgery-related risk factors for SSI include extended preoperative hospitalisation, massive intraoperative blood loss, and prolonged operative time.28

Internal fixation of a displaced acetabular fracture is one of the more complex orthopaedic procedures. Operative treatment often requires extensive surgical exposure, long operative time, and high blood loss. These patients often sustain multiple other traumatic injuries and require prolonged intensive care unit (ICU) stay. Some authors have proposed acetabular fracture specific risk factors for infection including associated Morel-Lavallée lesions, associated pelvic ring fractures, urinary tract injuries, antegrade femoral nailing, and embolisation of pelvic arterial injuries.7, 11, 13, 15, 23, 26

The purpose of this study was to assess the prevalence of patients with SSI who underwent acetabular fracture fixation, to delineate the clinical characteristics of the infection and its treatment, and to identify the risk factors for SSI.

Section snippets

Patients and methods

The study was approved by the institutional review board. We performed a retrospective review of trauma registries at a Level I Trauma Center. All consecutive patients who underwent fixation of acetabular fracture between January 2001 and December 2007 were identified. The definition of SSI was based on the Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance system.14 This definition includes deep SSI with an onset within 1 year and superficial infection with

Results

There were 326 patients including 250 males and 76 females with a mean age of 42.9 years old. Patient demographics are shown in Table 1, Table 2. The most frequent fracture type was posterior wall in 78 patients followed by both column in 69 patients. The mean BMI was 27.2 kg/m2. The approaches for internal fixation were posterior approach by Kocher–Langenbeck in 157 patients, anterior approach including ilioinguinal, modified Stoppa, and anterior (not extended) iliofemoral approach described by

Discussion

In our study, the overall prevalence of SSI was 5.2%, which was comparable to the previous studies where the infection rates of acetabular fracture fixation have been reported to be 3.5–5.0.10, 13, 16, 17, 18, 24 In univariate analysis, we identified that patients who developed SSI were more severely injured in terms of ISS and ICU stays. The operation was longer and estimated blood loss was larger in the SSI group. A total amount of PRBCs was significantly larger in the SSI group. Performance

Conflict of interest

All authors confirm that they have no financial and personal relationships with other people, or organisations, that could inappropriately influence (bias) this work.

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