Predictors of in-hospital surgical site infections in surgically managed acetabular fractures: A nationwide analysis

Authors

Justin M. Lapow, New York Medical College, School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
Antonio Lobao, New York Medical College, School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
Jason Kreinces, New York Medical College, School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
Jacob Feingold, New York Medical College, School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
Alexis Carr, New York Medical College, School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.Follow
Tim Sullivan, New York Medical College, School of Medicine, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
David S. Wellman, Department of Orthopaedic Surgery, Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10595, USA.
David E. Asprinio, Department of Orthopaedic Surgery, Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10595, USA.Follow

Author Type(s)

Student, Faculty

DOI

10.1016/j.jor.2023.10.001

Journal Title

Journal of Orthopaedics

First Page

48

Last Page

53

Document Type

Article

Publication Date

11-1-2023

Department

Orthopedic Surgery

Abstract

BACKGROUND: A surgical site infection (SSI) rate of 4%-8% has been reported in patients who undergo open reduction and internal fixation (ORIF) for acetabular fractures. Studies have identified risk factors for SSI, but none have performed a nationwide analysis of SSI in surgically managed acetabular fracture patients. METHODS: The National Inpatient Sample (NIS) database was queried for patients who underwent ORIF for acetabular fractures from 2016 to 2019. Analysis was performed on all patients who underwent ORIF for acetabular fractures, as well as those who only underwent ORIF for isolated acetabular fractures. Clinical characteristics, hospital course, discharge disposition, and hospitalization costs were compared between groups. Multivariate regression analysis was conducted to assess predictors of SSI. RESULTS: 41,725 patients undergoing acetabular fracture repair were identified, of which 490 (1.2%) developed SSI during hospitalization. Age (45.90 vs 49.90, p < 0.001) and Injury Severity Scale (5.99 vs 8.30, p < 0.001) were increased in patients who developed SSI. History of hypertension (HTN) (OR = 2.343, 95% CI 1.96-2.80, p < 0.001), longer hospital length of stay (30.27 days vs 10.00 days, p < 0.001) and total charges ($469,005 vs $193,032, p < 0.001) were associated with SSI. Lower rates of routine discharge were seen in SSI patients (OR = 0.333, 95% CI 0.260-0.426, p < 0.001). Higher rates of inpatient death were associated with SSI (OR = 2.210, 95% CI 1.172-4.17, p = 0.019). Multiple procedures in addition to acetabular fracture repair, iliac artery embolization, substance abuse, later time to internal fixation and HTN were predictive of SSI (p < 0.001). CONCLUSIONS: Severity of injury, time to fixation, and factors associated with compromised cardiovascular integrity were predictors of SSI. Identifying patients at risk for SSI should lead to clinical maneuvers that may optimize outcome.

Recommended Citation

Lapow, J. M., Lobao, A., Kreinces, J., Feingold, J., Carr, A., Sullivan, T., Wellman, D. S., & Asprinio, D. E. (2023). Predictors of in-hospital surgical site infections in surgically managed acetabular fractures: A nationwide analysis. Journal of Orthopaedics, 45, 48-53. https://doi.org/10.1016/j.jor.2023.10.001