Risk Factors of Surgical Site Infection after Acetabular Fracture Surgery

Surgical site infections (SSI) after acetabular fracture surgery are uncommon but devastating. It is still unknown which risk factors contribute to SSI. The primary objective of this study is to investigate the risk factors of SSI after acetabular fracture surgery.

A total of 338 patients who underwent the acetabular fracture surgical procedure were studied retrospectively. Post-operative SSI developed in 16 patients. From the medical record, age, gender, body mass index (BMI), Injury Severity Score (ISS), active smokers, diabetes mellitus, causes of fracture, associated injuries, classification of the acetabular fracture, time from injury to operation, operative approaches, use of the Intra-Aortic Balloon Occlusion (IABO), operative time, surgical blood loss, and days in the intensive care unit (ICU) were extracted. Univariate and multivariable analysis were performed to determine the association between risk factors and infection.

There were 10 males and six females in the infected group. According to the univariate analysis, the patients in whom SSI developed were more obese (higher BMI), more severely injured in terms of ISS, and had longer ICU stays. The operative time was longer, and estimated blood loss was larger in the infected group. Associated injuries such as Morel-Lavallée lesion, abdominal trauma, and urinary tract trauma were common in the infected group. Combined approaches and IABO were more commonly applied in the infected group. Multivariate analysis indicated that the operative time, Morel-Lavallée lesion, and abdominal trauma are the independent risk factors for SSI.

To reduce the incidence of SSI in patients with acetabular fractures, special attention should be paid to the obese patients, Morel-Lavallée lesion, and concomitant abdominal trauma. Keeping the operative time short also reduces the risk of SSI. It is important to perform surgical intervention immediately after the infection occurs.