Risk factors of surgical site infection in geriatric orthopedic surgery: A retrospective multicenter cohort study

As we are experiencing the progressive aging of our population, risk management of geriatric orthopedic patients is extremely important. The present study was carried out to identify independent predictors of surgical site infection and to better define the threshold value of serum albumin on postoperative wound infection in older patients.

This retrospective multicenter study was carried out from January 2015 to June in 2017. A total of 3378 older patients (aged ≥60 years) were enrolled. We extracted the patients' demographics, characteristics of disease, treatment-related variables and indexes of laboratory examination. Receiver operating characteristic analysis was carried out to find the optimum cut-off value for serum albumin. Univariate and multivariate logistic analysis models were carried out, respectively, to determine independent predictors of surgical site infection.

A total of 123 patients developed wound infection in the present study. Surgical site infection prolonged hospitalization of patients by a mean of 14.2 days. The overall incidence was 3.64%, with 0.47% for deep infection and 3.16% for superficial infection. Independent predictors of surgical site infection identified by multivariate analysis were traumatic injury (odds ratio 12.42, 95% CI 6.80-22.12; P = 0.000), serum albumin <32.6 g/L (odds ratio 2.54, 95% CI 1.22-5.29; P = 0.013) and American Society of Anesthesiologists physical status index class 3 or higher (odds ratio 2.14, 95% CI = 1.24-3.69; P = 0.006).

We recommend that surgeons evaluate the nutritional status of older patients and optimize the perioperative strategy of supplementary nutrition support to reduce the risk of postoperative wound infection. Geriatr Gerontol Int 2019; 19: 213-217.