Research Article

Risk factors of superficial surgical site infection post debridement and internal fixation of open fractures in long bones at Sanglah General Hospital, Bali, Indonesia

Stedy Adnyana Christian , Putu Astawa, I Ketut Suyasa

Stedy Adnyana Christian
Resident of Orthopaedics and Traumatology, Department of Orthopedic Sciences and Traumatology, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia. Email: saylovehoen@gmail.com

Putu Astawa
Department of Orthopedic Sciences and Traumatology, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

I Ketut Suyasa
Department of Orthopedic Sciences and Traumatology, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
Online First: April 30, 2021 | Cite this Article
Christian, S., Astawa, P., Suyasa, I. 2021. Risk factors of superficial surgical site infection post debridement and internal fixation of open fractures in long bones at Sanglah General Hospital, Bali, Indonesia. Intisari Sains Medis 12(1): 329-333. DOI:10.15562/ism.v12i1.897


Background: The fracture condition exposed to the environment can damage muscle, vascular, and nerve tissue due to infection. This study aims to determine whether age, Hb, OF grade II, duration and surgery time are risk factors of superficial surgical site infection for post-debridement and internal fixation in long bone fractures.

Methods: This study used cohort retrospective. Samples of patients with open long bone fractures at Sanglah Denpasar from February to July 2020 were assessed for their risk factors for infection based on secondary data from medical records, physical and laboratory examinations. Monitoring for infection incidence was performed 1-4 weeks postoperatively, based on clinical and infection markers (Procalcitonin). After that, descriptive and inferential statistical analysis was performed using the Chi-square test and Logistic Regression using SPSS version 24 for Windows.

Results: Hb level < 10 g/dLwas proven to be a risk factor (p=0.027). There was a significant difference in patients with grade II  (p=0.049; RR=10.00). There was a significant difference in the risk with patients with surgery duration ? 2 hours (p=0.011; RR=15). There was a significant difference in the patients with time to operation ? 12 hours (p=0.005; RR=8). Logistic Regression Test proves that the most influencing factor for superficial surgical site infection is operation duration (RR=9.328).

Conclusion: Hb, OF grade II, duration, and time to operation are risk factors of superficial surgical site infection for post-debridement and internal fixation in open fractures of the long bone. The most important risk factor for superficial surgical site infection is the duration of surgery.

References

Rubin RH. Surgical wound infection: epidemiology, pathogenesis, diagnosis and management. BMC Infect Dis. 2006;6:171.

Dominioni L, Imperatori A, Rotolo N, Rovera F. Risk factors for surgical infections. Surg Infect (Larchmt). 2006;7 Suppl 2:S9-S12.

Kaye KS, Schmit K, Pieper C, Sloane R, Caughlan KF, Sexton DJ, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis. 2005;191(7):1056-62.

Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res. 2002;103(1):89-95. d

Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt). 2017;18(6):722-735.

Westberg M, Snorrason F, Frihagen F. Preoperative waiting time increased the risk of periprosthetic infection in patients with femoral neck fracture. Acta Orthop. 2013;84(2):124-129.

Wester AL, Dunlop O, Melby KK, Dahle UR, Wyller TB. Age-related differences in symptoms, diagnosis and prognosis of bacteremia. BMC Infect Dis. 2013;13:346.

Alcântara JE JUNIOR, Aguiar RA, Sampaio JGL NETO, Azi ML, Sadigursky D, Alencar DF. Factors Associated with The Development of Early Infection After Surgical Treatment of Fractures. Acta Ortop Bras. 2018;26(1):22-26.

Borgohain M, Bora D, Rajan AD. A prospective study of the bacteriological profile and risk factors of infection after internal fixation of close fractures of long bones. Int J Res Orthop. 2020;6(2):345-352.

Kortram K, Bezstarosti H, Metsemakers WJ, Raschke MJ, Van Lieshout EMM, Verhofstad MHJ. Risk factors for infectious complications after open fractures; a systematic review and meta-analysis. Int Orthop. 2017;41(10):1965-1982.

Greenky M, Gandhi K, Pulido L, Restrepo C, Parvizi J. Preoperative anemia in total joint arthroplasty: is it associated with periprosthetic joint infection?. Clin Orthop Relat Res. 2012;470(10):2695-2701.

Kim PH, Leopold SS. In brief: Gustilo-Anderson classification. Clin Orthop Relat Res. 2012;470(11):3270-3274.

Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect. 2006;63(3):255-262.

Fernandes Mde C, Peres LR, de Queiroz AC Jr, Lima JQ Jr, Turíbio FM, Matsumoto MH. Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma. Acta Ortop Bras. 2015;23(1):38-42.


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