Journal of orthopaedic trauma · 2023
Predictors of Deep Infection After Distal Femur Fracture: A Multicenter Study.
Многоцентровое исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Brodke Dane, O'Hara Nathan, Devana Sai, Hernandez Adolfo, Burke Cynthia, Gupta Jayesh, McKibben Natasha, O'Toole Robert, Morellato John, Gillon Hunter, Walters Murphy, Barber Colby, Perdue Paul, Dekeyser Graham, Steffenson Lillia, Marchand Lucas, Fairres Marshall James, Black Loren, Working Zachary, Roddy Erika, El Naga Ashraf, Hogue Matthew, Gulbrandsen Trevor, Atassi Omar, Mitchell Thomas, Shymon Stephen, Lee Christopher
Аннотация
OBJECTIVES: To identify potentially modifiable risk factors for deep surgical site infection after distal femur fracture.
DESIGN: Multicenter retrospective cohort study.
SETTING: Ten Level-I trauma centers.
PATIENTS/PARTICIPANTS: Patients with OTA/AO 33A or C distal femur fractures (n = 1107).
INTERVENTION: Surgical fixation of distal femur fracture.
MAIN OUTCOME MEASUREMENT: The outcome of interest was deep surgical site infection.
RESULTS: There was a 7% rate (79/1107) of deep surgical site infection. In the multivariate analysis, predictive factors included alcohol abuse [odds ratio (OR) = 2.36; 95% confidence interval (CI), 1.17-4.46; P = 0.01], intra-articular injury (OR = 1.73; 95% CI, 1.01-3.00; P = 0.05), vascular injury (OR = 3.90; 95% CI, 1.63-8.61; P < 0.01), the use of topical antibiotics (OR = 0.50; 95% CI, 0.25-0.92; P = 0.03), and the duration of the surgery (OR = 1.15 per hour; 95% CI, 1.01-1.30; P = 0.04). There was a nonsignificant trend toward an association between infection and type III open fracture (OR = 1.73; 95% CI, 0.94-3.13; P = 0.07) and lateral approach (OR = 1.60; 95% CI, 0.95-2.69; P = 0.07). The most frequently cultured organisms were methicillin-resistant Staphylococcus aureus (22%), methicillin-sensitive Staphylococcus aureus (20%), and Enterobacter cloacae (11%).
CONCLUSIONS: Seven percent of distal femur fractures developed deep surgical site infections. Alcohol abuse, intra-articular fracture, vascular injury, and increased surgical duration were risk factors, while the use of topical antibiotics was protective.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Multicenter retrospective cohort study.
SETTING: Ten Level-I trauma centers.
PATIENTS/PARTICIPANTS: Patients with OTA/AO 33A or C distal femur fractures (n = 1107).
INTERVENTION: Surgical fixation of distal femur fracture.
MAIN OUTCOME MEASUREMENT: The outcome of interest was deep surgical site infection.
RESULTS: There was a 7% rate (79/1107) of deep surgical site infection. In the multivariate analysis, predictive factors included alcohol abuse [odds ratio (OR) = 2.36; 95% confidence interval (CI), 1.17-4.46; P = 0.01], intra-articular injury (OR = 1.73; 95% CI, 1.01-3.00; P = 0.05), vascular injury (OR = 3.90; 95% CI, 1.63-8.61; P < 0.01), the use of topical antibiotics (OR = 0.50; 95% CI, 0.25-0.92; P = 0.03), and the duration of the surgery (OR = 1.15 per hour; 95% CI, 1.01-1.30; P = 0.04). There was a nonsignificant trend toward an association between infection and type III open fracture (OR = 1.73; 95% CI, 0.94-3.13; P = 0.07) and lateral approach (OR = 1.60; 95% CI, 0.95-2.69; P = 0.07). The most frequently cultured organisms were methicillin-resistant Staphylococcus aureus (22%), methicillin-sensitive Staphylococcus aureus (20%), and Enterobacter cloacae (11%).
CONCLUSIONS: Seven percent of distal femur fractures developed deep surgical site infections. Alcohol abuse, intra-articular fracture, vascular injury, and increased surgical duration were risk factors, while the use of topical antibiotics was protective.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.