Surgical site infection following open reduction and internal fixation of a closed ankle fractures: A retrospective multicenter cohort study

BACKGROUND: Identification of risk factors for surgical site infection (SSI) after surgical ankle fractures was important, but related evidence was inadequate. This study was conducted to investigate the incidence and risk factors for SSI after open reduction and internal fixation (ORIF) of a closed ankle fractures. METHODS: Patients who underwent ORIF for a closed ankle fractures at 3 centers between July 2015 and January 2017 were included. Electronic medical recordings (EMR) and Picture Archiving and Communication Systems (PACS) were inquired for information on patients' clinical and radiographic characteristics. The potential factors include 4 aspects: demographics, injury-related, surgery-related and biochemical indictors. Factors related with SSI were analyzed by univariate and further by multivariate logistic regression model. RESULTS: During the hospitalization, 3.7% (46/1247) of patients developed SSI, with 1.12% (14/1247) for deep and 2.57% (32/1247) for superficial SSI. Approximately half of SSIs were caused by Methicillin-resistant Staphylococcus aureus (MRSA). After adjustment for confounding factors, higher body mass index (BMI), surgeon level (residents or treating surgeon), surgical duration>130mins, delayed surgery, preoperative TP < 60 g/L were significant risk factor or predictors for SSI occurrence. CONCLUSIONS: After comprehensive evaluation of patients medical conditions, immediate operation by a surgeon with more expertise could effectively reduce SSI occurrence.