Risk factors of deep infections after open reduction and internal fixation of closed tibial plateau fractures

doi:10.3877/cma.j.issn.1674-1358.2020.06.008

Abstract

Abstract:

Objective

To investigate the incidence of deep infection after open reduction and internal fixation (ORIF) for closed tibial plateau fractures (TPF), and to analyze the related risk factors.

Methods

From January 2012 to June 2018, a total of 252 patients with closed tibial plateau fractures who underwent open reduction and internal fixation were analyzed, retrospectively in Orthopedics Department, the Fifth People’s Hospital of Zhangjiagang City, including 172 males and 80 females. The basic preoperative data and risk indicators for infection (including trauma and surgery) were collected, respectively. The patients were divided into infection group (14 cases) and non-infection group (238 cases) according to whether deep infection occurred. The risk factors of TPF infection were evaluated by Logistic regression analysis.

Results

The most common pathogen of patients in infection group was Staphylococcus aureus (9/14, 64.29%), among which, 44.44% (4/9) strains were methicillin-resistant Staphylococcus aureus (MRSA). Compared with uninfected group, the prolonged hospital stay [(31.3 ± 16.5) d vs. (16.6 ± 4.8) d; t = 21.162, P < 0.001], increased intraoperative blood loss [(455.2 ± 713.1) ml vs. (255.7 ± 330.8) ml; t = 4.115, P = 0.016] andprolonged operation time [(196.4 ± 98.0) min vs. (124.5 ± 56.4) min; t = 10.522, P < 0.001] were significantly of patients in infection group. Single factor analysis showed that body mass index (BMI) ≥ 26.4 kg/m² (χ² = 12.428, P < 0.001), American Association of Anesthesiologists (ASA) grade 3 (χ² = 10.333, P = 0.001), Schatzker Ⅴ, Ⅵ (χ² = 4.166, P = 0.041), and prolonged operation time (χ² = 9.175, P = 0.002) were all high risk factors for deep infection. Logistic multivariate regression analysis showed that BMI > 26.4 kg/m² (OR = 1.192, P = 0.011), operation time > 148 min (OR = 3.769, P = 0.008), ASA grade ≥ 3 (OR = 1.240, P = 0.020) were all independent risk factors for deep infection.

Conclusions

The incidence of deep infection after open reduction and internal fixation of tibial plateau fractures was high. High BMI, prolonged operation time and ASA grade ≥ 3 were independent risk factors for deep infection.

Key words: Tibial plateau fractures, Deep infections, Open reduction and internal fixation, Risk factor

Hao Lu, Fei Yan. Risk factors of deep infections after open reduction and internal fixation of closed tibial plateau fractures[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(06): 485-489.

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References 25

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参数	感染组（14例）	未感染组（238例）	t值	P值
年龄（岁）	47.3 ± 15.1	45.2 ± 13.9	0.731	0.351
BMI（kg/m²）	27.3 ± 4.1	24.9 ± 3.4	5.133	0.004
术前等待时间（d）	6.7 ± 5.5	6.4 ± 5.1	0.451	0.772
住院天数（d）	31.3 ± 16.5	16.6 ± 4.8	21.162	< 0.001
术中失血量（ml）	455.2 ± 713.1	255.7 ± 330.8	4.115	0.016
术后引流量（ml）	180.8 ± 110.1	158.5 ± 88.5	1.182	0.255
手术时间（min）	196.4 ± 98.0	124.5 ± 56.4	10.522	< 0.001

参数	感染组（14例）	未感染组（238例）	t值	P值
年龄（岁）	47.3 ± 15.1	45.2 ± 13.9	0.731	0.351
BMI（kg/m²）	27.3 ± 4.1	24.9 ± 3.4	5.133	0.004
术前等待时间（d）	6.7 ± 5.5	6.4 ± 5.1	0.451	0.772
住院天数（d）	31.3 ± 16.5	16.6 ± 4.8	21.162	< 0.001
术中失血量（ml）	455.2 ± 713.1	255.7 ± 330.8	4.115	0.016
术后引流量（ml）	180.8 ± 110.1	158.5 ± 88.5	1.182	0.255
手术时间（min）	196.4 ± 98.0	124.5 ± 56.4	10.522	< 0.001

变量	临界值	ROC	95%CI	敏感性	特异性	P值
BMI（kg/m²）	26.4	0.711	0.643～0.880	0.815	0.793	0.004
术中失血量（ml）	310.5	0.660	0.481～0.852	0.591	0.715	0.016
手术时间（min）	148.0	0.801	0.614～0.917	0.694	0.720	< 0.001

变量	临界值	ROC	95%CI	敏感性	特异性	P值
BMI（kg/m²）	26.4	0.711	0.643～0.880	0.815	0.793	0.004
术中失血量（ml）	310.5	0.660	0.481～0.852	0.591	0.715	0.016
手术时间（min）	148.0	0.801	0.614～0.917	0.694	0.720	< 0.001

影响因素		感染组（14例）	未感染组（238例）	χ²值	P值
性别（男）		10（71.4）	162（68.1）	0.069	0.793
BMI（> 26.4 kg/m²）		11（78.6）	77（32.4）	12.428	< 0.001
吸烟		8（57.1）	102（42.9）	1.097	0.295
饮酒		4（28.6）	64（26.9）	0.019	0.890
高能量损伤		9（64.3）	110（46.2）	1.732	0.188
糖尿病		4（28.6）	31（13.0）	1.530	0.216
高血压		3（21.4）	40（16.8）	0.007	0.935
过敏史		0（0.0）	5（2.1）	0.192	0.661
ASA≥ 3级		5（35.7）	21（8.8）	10.333	0.001
Schatzker Ⅴ、Ⅵ		9（64.3）	88（37.0）	4.166	0.041
手术医师水平（副主任医师及以上）		13（92.9）	202（84.9）	0.673	0.412
抗菌药物使用时间
	术前	5（35.7）	63（26.5）	0.573	0.449
	术中	13（92.9）	225（94.5）	0.071	0.790
	术后	11（78.6）	184（77.3）	0.012	0.913
双钢板		8（57.1）	83（34.9）	2.842	0.091
手术时间（> 148 min）		10（71.4）	76（31.9）	9.175	0.002
术中失血量（> 310.5 ml）		6（42.9）	61（25.6）	2.010	0.156
输血		4（28.6）	36（15.1）	0.925	0.336

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