Risk factors of surgical site infection following surgical treatment of Pilon fractures

doi:10.3877/cma.j.issn.1674-134X.2022.03.008

Abstract

Abstract:

Objective

To investigate the risk factors of surgical site infection after Pilon fracture surgery.

Methods

The clinical data of 309 patients who underwent surgical treatment for Pilon fracture in Yangzhou Jiangdu People′s Hospital from January 2015 to June 2020 were analyzed retrospectively, excluding patients with a history of infection before admission. They were divided into two groups according to whether postoperative surgical site infection occurred. The gender, age, body mass index (BMI), smoking history, hypertension, diabetes history, fracture type, tension blister, joint dislocation, fracture classification, injury to operation time, postoperative drainage, operative time, surgical approach, anesthesiologist's anesthesia level (ASA), number of internal fixation plates, and whether used external fixing bracket temporarily in the two groups were compared. Statistical analysis included independent sample t test, chi square test or Fisher exact test. The statistically significant single factors were taken as independent variable for logistic regression analysis.

Results

A total of 309 patients were included in this retrospective study, including 25 cases of postoperative infection at the surgical site, with an infection rate of 8.1% (25/309). Twenty-two patients had positive results of incision secretion culture, with a positive rate of 88%. The most common pathogens were Staphylococcus aureus (7/22, 31.8%), Escherichia coli (6/22, 27.3%) and Staphylococcus epidermidis (4/22, 18.2%). Univariate analysis showed that there were significant differences in operation time, hypertension, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, open fracture and smoking history between the two groups (t=2.629, χ²=7.646, 12.184, 6.438, 14.268, all P<0.05). Multivariate logistic regression analysis showed that open fracture and smoking were independent risk factors for postoperative infection of Pilon fracture [odds ratio (OR)=3.770, 11.129, both P <0.05].

Conclusion

Open fracture and smoking are independent risk factors of surgical site infection after open reduction and internal fixation of Pilon fracture.

Key words: Ankle fractures, Fracture open reduction, Internal fracture fixation, Surgical site infection, Risk factors

Wenwen Mao, Hao Chen, Li Li, Yousen Zhu, Min Zhang, Gang Chen. Risk factors of surgical site infection following surgical treatment of Pilon fractures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(03): 309-314.

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References 26

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分组	例数	年龄(岁)	受伤至手术时间(d)	手术时间(min)	术后引流量(ml)	BMI(kg/m²)
感染组	25	47±9	13.6±4.9	120±51	85±31	26±3
未感染组	309	46±14	12.5±6.8	103±30	87±34	25±3
t值		0.397	0.725	2.629	0.285	1.139
P值		>0.05	>0.05	0.009	>0.05	>0.05

分组	例数	年龄(岁)	受伤至手术时间(d)	手术时间(min)	术后引流量(ml)	BMI(kg/m²)
感染组	25	47±9	13.6±4.9	120±51	85±31	26±3
未感染组	309	46±14	12.5±6.8	103±30	87±34	25±3
t值		0.397	0.725	2.629	0.285	1.139
P值		>0.05	>0.05	0.009	>0.05	>0.05

影响因素		感染组	未感染组	χ²值	P值
例数		25	284
性别	男	12	158	0.541	>0.05
性别	女	13	126	0.541	>0.05
高血压	有	13	74	7.646	0.006
高血压	无	12	210	7.646	0.006
糖尿病	有	7	116	1.582	>0.05
糖尿病	无	18	168	1.582	>0.05
吸烟史	有	19	106	14.268	0.001
吸烟史	无	6	178	14.268	0.001
开放性骨折	是	15	98	6.438	0.011
开放性骨折	否	10	186	6.438	0.011
AO分型	A型	1	84	12.184	0.002
	B型	6	92
	C型	18	110
ASA分级	Ⅰ、Ⅱ	14	182	0.647	>0.05
ASA分级	Ⅲ、Ⅳ	11	102	0.647	>0.05
张力性水泡	有	23	228	1.372	>0.05
张力性水泡	无	2	56	1.372	>0.05
合并脱位	有	9	69	1.668	>0.05
合并脱位	无	16	215	1.668	>0.05
钢板数量	≤2	13	197	3.183	>0.05
钢板数量	>2	12	87	3.183	>0.05
临时使用外固定支架	有	6	58	0.179	>0.05
临时使用外固定支架	无	19	226	0.179	>0.05
手术入路	内侧	10	156	6.173	>0.05
	前外侧	5	71
	前内侧	5	30
	后外侧	4	21
	后内侧	1	6

影响因素		感染组	未感染组	χ²值	P值
例数		25	284
性别	男	12	158	0.541	>0.05
性别	女	13	126	0.541	>0.05
高血压	有	13	74	7.646	0.006
高血压	无	12	210	7.646	0.006
糖尿病	有	7	116	1.582	>0.05
糖尿病	无	18	168	1.582	>0.05
吸烟史	有	19	106	14.268	0.001
吸烟史	无	6	178	14.268	0.001
开放性骨折	是	15	98	6.438	0.011
开放性骨折	否	10	186	6.438	0.011
AO分型	A型	1	84	12.184	0.002
	B型	6	92
	C型	18	110
ASA分级	Ⅰ、Ⅱ	14	182	0.647	>0.05
ASA分级	Ⅲ、Ⅳ	11	102	0.647	>0.05
张力性水泡	有	23	228	1.372	>0.05
张力性水泡	无	2	56	1.372	>0.05
合并脱位	有	9	69	1.668	>0.05
合并脱位	无	16	215	1.668	>0.05
钢板数量	≤2	13	197	3.183	>0.05
钢板数量	>2	12	87	3.183	>0.05
临时使用外固定支架	有	6	58	0.179	>0.05
临时使用外固定支架	无	19	226	0.179	>0.05
手术入路	内侧	10	156	6.173	>0.05
	前外侧	5	71
	前内侧	5	30
	后外侧	4	21
	后内侧	1	6

影响因素	B值	SE	Wald值	P值	OR	95%CI
吸烟史(有)	1.327	0.655	4.109	0.043	3.770	(1.045，13.600)
开放性骨折(有)	2.410	0.658	10.112	0.001	11.129	(2.520, 49.138)
手术时间	0.017	0.009	3.272	0.070	1.017	(0.999, 1.036)
高血压(有)	0.178	0.581	0.094	0.759	1.195	(0.383, 3. 734)
AO分型(C型)	0.554	0.586	0.893	0.345	1.739	(0.552, 5.485)

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