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Risk Factors for Surgical Site Infections After Orthopaedic Surgery in the Ambulatory Surgical Center Setting

Brophy, Robert H. MD; Bansal, Anchal MD; Rogalski, Brandon L. MD; Rizzo, Michael G. MD; Weiner, Eric J. MD; Wolff, Brett D. MD; Goldfarb, Charles A. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: October 15, 2019 - Volume 27 - Issue 20 - p e928-e934
doi: 10.5435/JAAOS-D-17-00861
Research Article

Introduction: This study was designed to determine the incidence of surgical site infections (SSIs) after orthopaedic surgery in an ambulatory surgery center (ASC) and to identify patient and surgical risk factors associated with SSI.

Methods: Patients who underwent orthopaedic surgery at an ASC over a 6.5-year period were reviewed for evidence of SSI. Data on patient and surgical factors were collected, and stepwise multivariate logistic regression determined the risk factors for SSI.

Results: The incidence of SSIs was 0.32%. Five independent factors were associated with SSI: anatomic area (odds ratio [OR] = 18.60, 11.24, 6.75, and 4.01 for the hip, foot/ankle, knee/leg, and hand/elbow versus shoulder, respectively), anesthesia type (OR = 4.49 combined general and regional anesthesia versus general anesthesia), age ≥70 (OR = 2.85), diabetes mellitus (OR = 2.27), and tourniquet time (OR = 1.01 per minute tourniquet time).

Discussion: The risk of infection after orthopaedic surgery in ASCs is low, but patient and surgical factors are independently associated with SSIs.

From the Department of Orthopaedic Surgery, Washington University, St. Louis, MO (Dr. Brophy, Bansal, Rogalski, Rizzo, Weiner, and Dr. Goldfarb), and the Department of Anesthesia, Washington University, Barnes-Jewish West County Hospital, Creve Coeur, MO (Dr. Wolff).

Correspondence to Dr. Brophy:

Dr. Brophy or an immediate family member serves as a board member, owner, officer, or committee member of American Orthopaedic Association and American Orthopaedic Society for Sports Medicine. Dr. Goldfarb or an immediate family member serves as a paid consultant to Arthrex and serves as a board member, owner, officer, or committee member of American Society for Surgery of the Hand. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Bansal, Dr. Rogalski, Dr. Rizzo, Dr. Weiner, and Dr. Wolff.

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Copyright 2018 by the American Academy of Orthopaedic Surgeons.
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