title: Surgical Site Infection In Orthopaedic Surgery: Correlation Between Age, Diabetes, Smoke And Surgical Risk.
abstract: Surgical site infection is a common complication after orthopaedic surgery. It can be associated with increased morbidity rate and social cost. The accurate identification of risk factors is essential so that strategies to prevent these potentially devastating infections can be developed. We have conducted this study to determine the possible risk factors for the surgical site infections.
  
  
  
  We aimed at finding exhaustive evidence concerning the potential risk factors for infections in orthopaedic surgery.
  
  
  
  Between October 2009 and December 2011, we identified 84 patients with a superficial and/or deep surgical site infection and compared them with 203 uninfected patients (control group), taken out from a series of 486 patients. We considered the following risk factors: diabetes, BMI >30, ASA Score of 3 or 4, smoking and age.
  
  
  
  The most frequently performed operations of the 287 examined patients were the knee and hip arthroplasties (n = 32, 11.14%) and open fracture reductions (n = 178, 62.02%). Staphylococcus Aureus was the most common identified pathogen (n = 63, 75%). The analyses (preoperative and postoperative) of the infected patients showed them to have significantly high serum glucose levels in comparison with the control group (odds ratio = 8.7). We found a significant high rate of infection in patients smoking for more than 20 years (67 patients, 79.7%). The remaining variables (BMI, OR = 2.21; ASA score, OR = 1.3) showed no significant differences between the study group and controls. We also found a correlation between > 65-year-old patients and infections at the surgical site (61 patients, 72.6%).
  
  
  
  We found that there was correlation between diabetes, smoking and age as risk factors with the development of infection at the surgical site; other variables such as the ASA score and BMI are not relevant here (contrary to what is reported in literature). We believe that postoperative results can be improved considerably with a properly conducted antibiotic treatment, stringent glycemic control (achievable only with careful multidisciplinary management) and good compliance of patients.
authors.affiliation: Department of Biomedical Sciences, Morphological and functional imaging, Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
authors.forename: Leonardo
authors.initials: L
authors.lastname: Fisichella
authors.affiliation: Department of Biomedical Sciences, Morphological and functional imaging, Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
authors.forename: Domenico
authors.initials: D
authors.lastname: Fenga
authors.affiliation: Department of Biomedical Sciences, Morphological and functional imaging, Section of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
authors.forename: Michele Attilio
authors.initials: MA
authors.lastname: Rosa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D019637:Orthopedic Procedures; D010019:Osteomyelitis / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology*