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Incidence and Risk Factors of Infection After Fracture Fixation: A Multicenter Cohort Study
Baisheng Wang1,2, Jingdong Zhang3, Wenfeng Han4
1Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.
Purpose:
Infection after fracture fixation (IAFF) is a severe complication. There are few multicenter studies targeting IAFF. This paper identifies independent risk factors associated with IAFF by analyzing multicenter clinical data. Appropriate interventions should be implemented to reduce the risk of IAFF.
Methods:
This is a multicenter retrospective cohort study. This study screened medical records of patients who underwent internal fixation for fractures at participating medical institutions from January 1, 2011, to December 31, 2020. Data extraction included demographic characteristics, disease features, surgical variables, and laboratory indicators. Logistic regression analysis was employed to identify the relationship between relevant risk factors and IAFF. Research data were sourced from the hospital's electronic medical record system and self-constructed databases.
Results:
In our study, 202 patients who underwent internal fixation for fractures experienced postoperative infections, which corresponds to an overall incidence rate of approximately 1.7%. The predominant pathogen identified in these infections was Staphylococcus aureus. A multifactorial analysis indicated that several factors were independently associated with the occurrence of IAFF. These factors included BMI ranges of 24.0-27.9 and 28.0-31.9, smoking, a high ASA score, high-energy trauma, diabetes, open fracture, seasonal timing of the surgery (summer), bone grafting, drainage duration, surgical duration ≥ 180 min, and A/G ratio < 1.2.
Conclusions:
We strongly recommend that orthopedic surgeons perform comprehensive preoperative assessments on fracture patients to identify factors that may increase the risk of infection. Through the implementation of targeted interventions and beneficial modifications to these modifiable risk factors, it is possible to lower the incidence of IAFF. Additionally, proactive screening, risk stratification, and thorough patient education should be prioritized for patients with high risk but nonmodifiable factors.
Insights
Identifying risk factors for infection after fracture fixation (IAFF) is crucial. This multicenter study found that factors like higher BMI, smoking, diabetes, and longer surgery increase IAFF risk, guiding targeted interventions.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Clinical Epidemiology
Background:
- Infection after fracture fixation (IAFF) is a significant complication impacting patient outcomes.
- Multicenter studies investigating IAFF risk factors are limited, necessitating further research.
- Understanding these factors is key to developing effective prevention strategies.
Purpose of the Study:
- To identify independent risk factors associated with IAFF using multicenter clinical data.
- To analyze demographic, clinical, and surgical variables contributing to IAFF.
- To inform targeted interventions for reducing IAFF incidence.
Main Methods:
- A multicenter retrospective cohort study design.
- Screening of medical records for patients undergoing internal fracture fixation (2011-2020).
- Logistic regression analysis to determine independent risk factors for IAFF.
Main Results:
- The overall incidence of IAFF was approximately 1.7% (202 cases).
- Staphylococcus aureus was the predominant pathogen.
- Independent risk factors identified include elevated BMI, smoking, high ASA score, high-energy trauma, diabetes, open fractures, summer surgery, bone grafting, prolonged drainage, extended surgical duration (≥180 min), and low A/G ratio (<1.2).
Conclusions:
- Comprehensive preoperative assessment is recommended to identify patients at increased risk of IAFF.
- Modifiable risk factors should be targeted with specific interventions to lower IAFF rates.
- Proactive screening, risk stratification, and patient education are vital for high-risk individuals, especially those with nonmodifiable factors.
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