Distribution of putative SSI risk factors in adults undergoing open reduction and fixation of long bone fracture.

PURPOSE: Surgical site infection (SSI) is a potentially devastating complication following surgery and can result in a significant burden to patients and healthcare providers. Our study reports the risk and putative risk factors for SSI after open reduction and internal fixation (ORIF) of long bone fractures.

METHODS

We report findings from a large multicentre observational cohort undertaken in 49 National Health Service (NHS) hospitals in England between January 2010 to March 2020. Patients were prospectively followed up during their inpatient stay and post-discharge to identify SSI meeting standardised case definitions within a year of surgery.

RESULTS

A total of 22,073 long bone ORIF procedures were included, with a median patient age of 59.1 years (IQR 40.1-75.0). Of these, 236 (1.07%) developed an SSI, with a median time onset of 17 days (IQR 11.0-30.2 days). Just under half (43.6%) were deep incisional and 11.0% organ space SSIs. Of monomicrobial infections, meticillin-sensitive Staphylococcus aureus (44.1%) was the most common causative pathogen. An ASA score of 4 was particularly associated with an increased risk of infection, compared against patients with an ASA score of 1 (risk difference: 2.30 95% CI 1.22-3.38, p < 0.001). Patients with SSI were more likely to have surveillance discontinued due to death than patients without SSI (RD:1.77, 95% CI - 0.54-4.09, p = 0.060).

CONCLUSION

Our results highlight the risk of infection following surgery on long bone fractures and identify patient and procedure factors associated with elevated risk. Clinicians should focus on mitigating these risk factors to minimize harm due to SSIs.