G. H. Saadat1, R. S. Toor1, A. Khalifa1, C. A. Jaber1, A. Pires-Menard1, F. Bryan1, A. Qureshi1, F. Bajani1, M. Kaminsky1, F. Bokhari1 1Stroger Hospital of Cook County,Trauma And Burn Surgery,Chicago, IL, USA
Introduction:
Surgical wound classification (clean, clean/contaminated, contaminated, and dirty) is a reliable predictive model for post-operative rate of infection amongst general surgery patients. We hypothesized that surgical wound classification can predict post-operative surgical site infections in orthopedic patients as well.
Methods:
The ACS-NSQIP database was queried for patients admitted in 2017. All surgical cases with orthopedic surgery as principal operative procedure were included. Cases identified as non-emergent or elective were excluded. Patients presented with surgical site infection at the time of surgery were also excluded.
Patients were stratified by surgical wound classification. Surgical site infection rates for superficial incisional infection, deep incisional infection, and organ/space infections were analyzed among these four wound groups.
Results:
9,440 patients met the inclusion criteria. Overall, more patients were female (5264/9440, 59.6%), average age was 68.25 and average length of stay was 6.8 days.
The incidences of wounds considered clean, clean/contaminated, contaminated and dirty were 86.9%, 2.5%, 2.9% and 7.7% respectively. A total of 146 (1.5%) patients developed any surgical site infection and 35 (23.9%) of those were deep SSI (p<0.001).
Deep SSI was statistically significant for clean and dirty wounds (p<0.001). The presence of a dirty wound increased the odds of a deep SSI by 5.7 times, respectively (p<0.001).
Conclusion:
Clean wounds have a significantly low rate of deep SSI in non-elective orthopedic patients. In orthopedic patients, surgical wound classification is a good predictor of deep post-surgical site infection.
