Christian Willy1, Hayo Rieger2, Marcus Stichling2. 1. Klinik für Unfallchirurgie, Orthopädie, Septisch-Rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum Septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13,, 10115, Berlin, Deutschland. christianwilly@bundeswehr.org. 2. Klinik für Unfallchirurgie, Orthopädie, Septisch-Rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum Septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13,, 10115, Berlin, Deutschland.
Abstract
BACKGROUND: Despite the many scientific and technological advances postoperative infection continues to be a large problem for trauma and orthopedic surgeons. Based on a review of the current literature, this study provides a comprehensive overview of the risk factors (RF) and possible preventive measures to control surgical site infections. METHODS: Medline search and analysis from 1968-2017 (as of 01 March 2017). Selection of trauma and orthopedic relevant RFs and comparison with WHO recommendations (global guidelines for the prevention of surgical site infection, Nov. 2016). RESULTS: Identification of 858 relevant articles from the last 50 years (1968-2017). Pooled postoperative rate of infection is 0.3% (hand surgery) and 19% (3rd degree open fractures). For open fractures, there is no clear tendency towards lower infection rates during the past five decades. Identification of 115 RF from three areas (patient-dependent RF, organizational and procedural RF, trauma- and surgery-dependent RF). The five most important RFs are body mass index over 35 kg/m2, increased duration of surgery, diabetes mellitus, increased blood glucose levels in the perioperative period also in the case of nondiabetic patients, and errors in the perioperative antibiotic prophylaxis. DISCUSSION: Inconsistent definition of "infection", interaction of the RF and the different follow-up duration limit the meaningfulness of the study. CONCLUSION: In the future, considerable efforts must be made in order to achieve a noticeable reduction in the rate of infection, especially in the case of high-risk patients.
BACKGROUND: Despite the many scientific and technological advances postoperative infection continues to be a large problem for trauma and orthopedic surgeons. Based on a review of the current literature, this study provides a comprehensive overview of the risk factors (RF) and possible preventive measures to control surgical site infections. METHODS: Medline search and analysis from 1968-2017 (as of 01 March 2017). Selection of trauma and orthopedic relevant RFs and comparison with WHO recommendations (global guidelines for the prevention of surgical site infection, Nov. 2016). RESULTS: Identification of 858 relevant articles from the last 50 years (1968-2017). Pooled postoperative rate of infection is 0.3% (hand surgery) and 19% (3rd degree open fractures). For open fractures, there is no clear tendency towards lower infection rates during the past five decades. Identification of 115 RF from three areas (patient-dependent RF, organizational and procedural RF, trauma- and surgery-dependent RF). The five most important RFs are body mass index over 35 kg/m2, increased duration of surgery, diabetes mellitus, increased blood glucose levels in the perioperative period also in the case of nondiabetic patients, and errors in the perioperative antibiotic prophylaxis. DISCUSSION: Inconsistent definition of "infection", interaction of the RF and the different follow-up duration limit the meaningfulness of the study. CONCLUSION: In the future, considerable efforts must be made in order to achieve a noticeable reduction in the rate of infection, especially in the case of high-risk patients.
Authors: Mohammad R Rasouli; Camilo Restrepo; Mitchell G Maltenfort; James J Purtill; Javad Parvizi Journal: J Bone Joint Surg Am Date: 2014-09-17 Impact factor: 5.284
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Authors: Anouschka P H Sahtoe; Liron S Duraku; Mark J W van der Oest; Caroline A Hundepool; Marjolein de Kraker; Lonneke G M Bode; J Michiel Zuidam Journal: Plast Reconstr Surg Glob Open Date: 2021-07-27