Host-Related Predictors of Wound Complications After Elective Ankle Hardware Removal

IntroductionElective ankle hardware removal is classified as a clean surgical procedure, although postoperative wound complications remain a relevant source of morbidity. The role of routine preoperative antibiotic prophylaxis in this setting remains uncertain.MethodsA retrospective observational study was conducted including patients who underwent elective ankle hardware removal between 2019 and 2025. The primary outcome was postoperative wound complications. Univariate analysis and multivariable logistic regression were performed.ResultsA total of 160 patients were included, and wound complications occurred in 13 patients (8.1%). In univariate analysis, older age, higher body mass index, active smoking, peripheral vascular disease, and an estimated glomerular filtration rate <90 mL/min/1.73 m² were associated with wound complications. The exploratory high clinical-risk group had a higher complication rate than the low-risk group (14.3% vs 1.5%; P = .007). In the multivariable analysis, age (odds ratio [OR] 1.067; 95% confidence interval [CI] 1.014-1.122; P = .012), body mass index (OR 1.166; 95% CI 1.025-1.325; P = .019), and active smoking (OR 4.90; 95% CI 1.19-20.00; P = .028) were associated with wound complications. Wound complication rates were identical between patients who did and did not receive preoperative cefazolin (7.7% vs 7.7%; P = 1.000).ConclusionsThese findings highlight older age, BMI, and active smoking as factors to consider during preoperative risk assessment before elective ankle hardware removal. No association between preoperative antibiotic prophylaxis and wound complications was observed; however, this finding should be interpreted cautiously given the limited number of patients who received preoperative antibiotics.Level of Evidence:Level III, retrospective observational study.