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Risk factors for deep surgical site infection in patients with operatively treated tibial plateau fractures: A retrospective multicenter study.

OBJECTIVES
To identify the potential controllable risk factors for surgical site infection (SSI).


DESIGN
Retrospective cohort study.


SETTING
Seven level-I trauma centers.


PATIENTS/PARTICIPANTS
Patients with OTA/AO 41 B or C tibial plateau fractures (TPFs) (n=2106).


INTERVENTION
Various surgical treatments for TPFs.


MAIN OUTCOME MEASUREMENTS
The primary outcome was SSI after the index operation. The secondary outcomes were the risk factors for SSI, identified using backward stepwise generalized multiple regression analysis.


RESULTS
Of the 2,106 enrolled patients, 94 had deep SSIs. The average SSI rate was 4.5%. Fracture morphology revealed type B injuries in 57.5% and type C in 42.5% of the patients. Univariate regression analysis revealed that several factors, namely, number of comorbidities (>6 versus none; odds ratio [OR] 8.01, 95% confidence interval [CI] 2.8-22.8, p<0.001), diabetes mellitus (OR 3.5, 95% CI 2.0-6.3, p<0.001), high BMI (OR 1.3, 95% CI 1.1-1.6, p=0.001), AO fracture type C (OR 5.6, 95% CI 3.3-9.5, p<0.001), compartment syndrome (OR 9.1, 95% CI 5.7-14.8, p<0.001), and open fracture (OR 6.6, 95% CI 3.7-11.7, p<0.001), were associated with a significantly higher SSI risk. Analysis of microbial sensitivity tests revealed that 55.1% of the pathogens were resistant to perioperative antibiotic prophylaxis (PAP).


CONCLUSIONS
Most of the identified risk factors cannot be controlled or are subject to other factors that are difficult to control. However, our data suggest that the choice of PAP may influence the rate of SSI. This possibility should be investigated in a prospective randomized controlled trial.


LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.