Analysis of risk factors affecting wound infection after open ankle fracture surgery

This study aimed to analyze the incidence and risk factors associated with surgical site infection (SSI) following open reduction and internal fixation (ORIF) for ankle fractures. This retrospective study collected clinical data from patients who underwent ORIF for ankle fractures at Tianjin Hospital between January 2018 and January 2023. Patients were divided into an infection group and a noninfection group based on whether they developed SSI within 1-year after surgery. The general characteristics and laboratory test results of the 2 groups were compared. Univariate analysis and multivariate logistic regression were used to identify risk factors for SSI following ORIF. A total of 809 patients met the inclusion criteria, of which 76 patients (9.39%) developed SSI and were included in the infection group, while 733 patients who did not develop SSI were included in the noninfection group. Univariate analysis revealed that a body mass index (BMI) ≥28 kg/m², high-energy injury, comorbid diabetes, class II surgical wound, prolonged operative time, American Society of Anesthesiologists classification III-IV, elevated white blood cell count, decreased red blood cell count, serum albumin levels <35 g/L, blood glucose levels ≥6.1 mmol/L, and prolonged hospital stay were significantly associated with the occurrence of SSI (P < .05). Multivariate logistic regression analysis identified BMI ≥ 28 kg/m², high-energy injury, comorbid diabetes, class II surgical wound, prolonged operative time, and serum albumin levels <35 g/L as independent risk factors for SSI following ORIF in patients with ankle fractures (odds ratio > 1; P < .05). Patients with a preoperative BMI ≥ 28 kg/m², high-energy injury, comorbid diabetes, class II surgical wound, prolonged operative time, and preoperative serum albumin levels <35 g/L are at an increased risk of developing SSI following ORIF for ankle fractures. For these patients, proactive preoperative preventive measures should be taken to reduce the incidence of postoperative SSI.