Incidence and risk factors of postoperative infection after wrist arthroscopy: an 11-year nationwide population-based cohort study in South Korea.

BACKGROUND

Wrist arthroscopy is increasingly used for various wrist disorders, but postoperative infection remains a rare yet serious concern. To date, no nationwide study has comprehensively analyzed its incidence and risk factors.

HYPOTHESIS: We hypothesized that postoperative infection after wrist arthroscopy is uncommon but associated with specific demographic and surgical risk factors.

PATIENTS AND

METHODS

Using the Korean National Health Insurance Service (NHIS) database, all wrist arthroscopies performed between 2013 and 2022 were identified. Procedures were classified as diagnostic arthroscopy (P1), synovectomy/excision (P2), and tendon/ligament reconstruction (P3). Postoperative infection was defined as a newly assigned infection code within 4 weeks, and deep infection as one requiring repeat surgery within 3 months. Multivariable logistic regression identified independent risk factors.

RESULTS

Of 42,901 wrist arthroscopies, 35,141 met inclusion criteria. Postoperative infection occurred in 1,263 cases (3.6%), of which 94 (0.27%) were classified as deep infections requiring repeat surgery, while the majority were superficial infections managed nonoperatively. Infected patients were older (47.7 ± 16.4 vs 43.4 ± 15.6 years). The annual infection rate peaked in 2014 (∼5%) and declined to 2.7% in 2022. Independent predictors included older age, male sex (OR 1.23, 95% CI 1.09-1.39, p = 0.001), hypertension, rheumatoid arthritis, higher Charlson Comorbidity Index, and synovectomy/excision (P2) (OR 1.22, 95% CI 1.06-1.40, p = 0.0006). Infections were less frequent in Gyeonggi province (OR 0.70) but slightly higher in other metropolitan regions (OR 1.21), while socioeconomic status was not significant.

DISCUSSION: Postoperative infection after wrist arthroscopy is uncommon but clinically relevant, particularly in elderly, male patients with systemic comorbidities or undergoing synovectomy. These nationwide findings provide reliable risk estimates to guide perioperative counseling and targeted infection-prevention strategies.

LEVEL OF EVIDENCE: III.