Elevated risk of wound and systemic complications in MRSA-colonized patients undergoing lower extremity orthopedic trauma surgery

Preoperative colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a known risk factor for adverse outcomes in arthroplasty but remains under-investigated in orthopedic trauma. This study evaluates the impact of preoperative MRSA colonization on postoperative complication rates in patients undergoing lower extremity orthopedic trauma surgery. We conducted a retrospective cohort study using the TriNetX Research Network, identifying adult patients who underwent lower extremity orthopedic trauma procedures over a 20-year period. Patients with a documented MRSA diagnosis within three months before surgery were matched 1:1 to MRSA-negative controls based on demographics and comorbidities. Postoperative outcomes were assessed within three months of surgery, including surgical site infections (SSIs), wound dehiscence, organ dysfunction, thromboembolic events, and healthcare utilization. Odds ratios (ORs) and p-values were calculated, with statistical significance set at p < 0.05. A total of 1,868 MRSA+ and 629,342 control patients were identified. After matching, MRSA+ patients remained at significantly increased risk for wound dehiscence (OR = 1.80, p = 0.005), pneumonia (OR = 2.33, p < 0.001), sepsis (OR = 3.71, p < 0.001), acute renal failure (OR = 1.45, p < 0.001), blood transfusion (OR = 1.74, p < 0.001), deep vein thrombosis (OR = 2.29, p < 0.001), and pulmonary embolism (OR = 2.80, p < 0.001). No significant differences in SSIs were observed after matching. Preoperative MRSA colonization is associated with increased risks of wound dehiscence, pneumonia, sepsis, thromboembolic events, blood transfusions, and acute renal failure in orthopedic trauma patients. Preoperative MRSA screening may serve as a risk-stratification tool, enabling surgeons to anticipate systemic complications and optimize management. Where feasible, screening with targeted decolonization or prophylactic strategies may mitigate risk. MRSA colonization in orthopedic trauma is linked to systemic complications after surgery and wound dehiscence. No significant increase in surgical site infections after matching for comorbidities. MRSA positivity may reflect patient frailty and overall vulnerability, not direct infection risk. Screening for MRSA can aid risk stratification and optimize perioperative management. Findings support investigating standardized screening and decolonization protocols in trauma care.