title: Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction.
abstract: OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008. METHODS We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients' demographic characteristics, comorbidities, and choice of graft. RESULTS On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%-1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%-3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8-12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3-4.8). CONCLUSIONS The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients. Infect Control Hosp Epidemiol 2016;37:827-833.
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Murphy
authors.affiliation: 2Office of Biostatistics and Epidemiology,Center for Biologics Evaluation and Research,Food and Drug Administration,Rockville,Maryland.
authors.forename: Dongyi Tony
authors.initials: DT
authors.lastname: Du
authors.affiliation: 2Office of Biostatistics and Epidemiology,Center for Biologics Evaluation and Research,Food and Drug Administration,Rockville,Maryland.
authors.forename: Wei
authors.initials: W
authors.lastname: Hua
authors.affiliation: 3Office of Cellular,Tissue and Gene Therapies,Center for Biologics Evaluation and Research,Food and Drug Administration,Rockville,Maryland.
authors.forename: Karoll J
authors.initials: KJ
authors.lastname: Cortez
authors.affiliation: 4Center for Clinical & Outcomes Research,Kaiser Permanentema,Atlanta,Georgia.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: 4Center for Clinical & Outcomes Research,Kaiser Permanentema,Atlanta,Georgia.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davis
authors.affiliation: 5Department of Orthopaedics and Rehabilitation,University of New Mexico School of Medicine,Albuquerque,New Mexico.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: DeCoster
authors.affiliation: 6Center for Health Services Research,Henry Ford Health System,Detroit,Michigan.
authors.forename: Laura
authors.initials: L
authors.lastname: Johnson
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.affiliation: 7Center for Health Research,Kaiser Permanente Hawaii,Honolulu,Hawaii.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Nakasato
authors.affiliation: 8HealthPartners Institute for Education and Research,Minneapolis,Minnesota.
authors.forename: James D
authors.initials: JD
authors.lastname: Nordin
authors.affiliation: 6Center for Health Services Research,Henry Ford Health System,Detroit,Michigan.
authors.forename: Mayur
authors.initials: M
authors.lastname: Ramesh
authors.affiliation: 9Health Services Research Division,LCF Research,Albuquerque,New Mexico.
authors.forename: Michael
authors.initials: M
authors.lastname: Schum
authors.affiliation: 9Health Services Research Division,LCF Research,Albuquerque,New Mexico.
authors.forename: Ann
authors.initials: A
authors.lastname: Von Worley
authors.affiliation: 2Office of Biostatistics and Epidemiology,Center for Biologics Evaluation and Research,Food and Drug Administration,Rockville,Maryland.
authors.forename: Craig
authors.initials: C
authors.lastname: Zinderman
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000379:methods; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017847:Patellar Ligament / Q000637:transplantation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000209:etiology*; D055815:Young Adult