Documented Penicillin Allergy Is Associated with Increased Post-Operative Complications Following Lower Extremity...

Penicillin allergy is a risk factor for infection in an elective orthopedic surgical procedure, but this has not been studied in orthopedic trauma. We hypothesize there will be an increase in deep surgical site infections in patients sustaining lower extremity fractures with documented penicillin allergy.

A retrospective cohort study was performed at an academic, level-one trauma center of patients who underwent surgical fixation of lower extremity fractures. Cohorts were divided based on the documented presence of a penicillin allergy in the medical record. The primary outcome analyzed was deep infection. Multi-variable logistic regression and propensity score matching were performed to control for confounding patient baseline characteristics.

Of the 2,559 patients reviewed, 2,085 met the inclusion criteria: A total of 234 with documented penicillin allergy and 1,851 without. The penicillin-allergic cohort had higher rates of tobacco use (64.1% vs. 53.4%, p = 0.002), diabetes mellitus (23.1% vs. 16.9%, p = 0.02), peripheral vascular disease (9.8% vs. 3.8%, p < 0.001), and chronic kidney disease (14.5% vs. 9.0%, p = 0.007). After matching for confounding factors, penicillin allergy was not associated with deep infection (odds ratio [OR] = 1.01; p = 0.859) but was significantly associated with increased risk of superficial infection (OR = 2.05; p = 0.002), overall complication (OR = 2.20; p = 0.006), delayed wound healing (OR = 3.77; p < 0.001), and amputation (OR = 5.62; p = 0.002).

Our results suggest that documented penicillin allergy is a risk factor for post-operative complications in lower extremity trauma cases. Surgeons should consider these findings when determining pre-operative antibiotic agent prophylaxis and during patient counseling.