Risk factors for surgical site infections following clean orthopaedic operations

Surgical site infections can follow clean orthopaedic operations and can cause serious morbidity, mortality and increased resource utilization. Despite this, there are few studies on risk factors for surgical site infections in the Nigerian orthopaedic literature. We conducted a prospective study to determine the host and environmental risk factors for surgical site infections following clean orthopaedic operations.

Consecutive patients who satisfied the inclusion criteria and were to undergo clean orthopaedic operations performed at the National Orthopaedic Hospital, Igbobi, Lagos from January 2007 to July 2008 were included. Patient's biodata, duration of preoperative hospitalization and other risk factors were analyzed. The risk factors for surgical site infection were determined with Chi square test.

The overall rate of surgical site infection during the 18 months of the study was 9.9% (12 of 121). Independent risk factors for this were: Prolonged duration of preoperative hospital stay greater than 13 days (21% infection rate), increasing age greater than 60 years (31% infection rate), and use of implants and drains (only one un-drained wound was infected).

Patient's age, duration of preoperative hospitalization, type of surgery (implant or non-implant), and use of drains were the most significant risk factors affecting surgical site infection. It is recommended that preoperative hospital stay should be as short as possible and extra care/precautions taken when working on the elderly, using implants or requiring drainage.