The risk of surgical site infection, septic arthritis, and osteomyelitis after hand trauma surgery.

AIMS: The risk of surgical site infection (SSI) in hand trauma surgery is estimated to be approximately 5% to 10%. However, the severity of these SSIs remains unclear. We aimed to determine the risk of deep SSI, septic arthritis, and osteomyelitis following hand trauma surgery using Hospital Episode Statistics data, a source of routinely collected national healthcare data in England.

METHODS

This was a national cohort study of hand trauma surgery in the NHS in England over 22 years, split into four sub-cohorts of the most common hand trauma operations: hand fracture fixation; flexor tendon repair; extensor tendon repair; and nerve repair. The primary outcome was readmission for deep SSI, septic arthritis, or osteomyelitis following hand trauma surgery at 30 and 90 days.

RESULTS

There were 280,747 cases across the study period. A total of 4,013 postoperative infections, including deep SSI, septic arthritis, and osteomyelitis, occurred by 30 days, and 5,563 by 90 days. This corresponds to a severe SSI risk of 1.4% (95% CI 1.4 to 1.5) by 30 days and 2.0% (95% CI 1.9 to 2.0) by 90 days following common hand trauma surgery. Data for each cohort indicated a higher risk of osteomyelitis in fracture fixation and a higher risk of deep SSI in soft-tissue reconstruction.

CONCLUSION

The risk of readmission for deep SSI, septic arthritis, or osteomyelitis following hand trauma surgery is 1.4% at 30 days, rising to 2% at 90 days. These data can be used to inform patients of their risk and to guide future research in hand trauma surgery.