1. Incidence and Predictors of Surgical Site Infections Following Foot and Ankle Surgery at a Tertiary Care Center in Riyadh, Saudi Arabia
AlKenani NS, AlSultan AS, AlOsfoor MA, Bahkali M, AlMohrej OA, AlGhnam S
Introduction:
Surgical site infections (SSIs) have significant impact on morbidity, mortality, healthcare cost, the length of patients’ hospitalization. SSI is the second most common type of hospital-acquired infection. In the area of orthopedics, foot and ankle surgery has a higher rate of SSIs among other elective orthopedic procedures (1).
Aim & Objectives:
To estimate the incidence of surgical site infection among patients underwent foot and ankle surgery between
To determined predictors of surgical site infection among patients who underwent foot and ankle surgery between
Methods:
This is a retrospective cohort chart review of all patients who underwent foot and ankle surgery between 2010 and 2014 at National Guard Hospital, Riyadh, Saudi Arabia. . To the best of the study, 295 subjects who underwent 353 surgeries were selected using convenient sampling. The data collected included the following variables: patients’ demographics, laboratory investigations, surgery related data, co- morbidities, pre-operative medication and National Nosocomial Infection surveillance. Data were analyzed using Statistical Analysis Software (SAS®) version The association of independent variables with the infection was analyzed using logistic regression model. The strength of association will be estimated using Odds Ratio with 95% confidence.
Results:
The study included 353 surgeries performed on 295 patients. The overall incidence of SSI following foot and ankle surgery was 3.42%. Adults (≥ 18) were the majority with significant association with infection (P. = 0.024). Type of surgery and National Nosocomial Infection surveillance (NNIS) score were the significant predictors after running logistic regression model.
Discussion:
The incidence of this study lies between the documented incidence in literature of 1.0% to 6.5%. In Saudi Arabia, Al-Mulhim et al study, the incidence rate of SSI in orthopedic department was 2.55% (2-4).
Several studies reported that male gender is more prone to contract SSI. This might be attributable to the greater bacterial colonization of the skin on men, and hair growth and shaving habits (5).
This study confirms previous findings about the association between increased age and an increase in the risk of SSI. This might be due to the well known association between aging and immune dysfunction (6-8).
According to NNIS score calculation for all the patients, 10.34% of the procedures labeled mild to moderate risk acquired SSI.
Conclusion / Recommendations:
The incidence of the study is within the reported incidence locally and internationally. Increased age, type of surgery and NNIS score were found to be independent risk factors for development of surgical site infection following foot and ankle surgery. NNIS score calculation is recommended to all patients undergoing surgery. Include surgeries from all orthopedic subspecialty and compare SSI outcomes. This study would probably have more precise results if it were a prospective rather than a retrospective chart review and has larger sample size.
References:
Ralte P, Molloy A, Simmons D, Butcher C. The effect of strict infection control policies on the rate of infection after elective foot and ankle surgery: a review of 1737 cases. Bone Joint J. 2015;97- B(4):516-9.
Butterworth P, Gilheany MF, Tinley P. Postoperative infection rates in foot and ankle surgery: a clinical audit of Australian podiatric surgeons, January to December Aust Health Rev. 2010;34(2):180-5.
Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):
Al-Mulhim FA, Baragbah MA, Sadat-Ali M, Alomran AS, Azam MQ. Prevalence of surgical site infection in orthopedic surgery: a 5-year analysis. Int Surg. 2014;99(3):264-8.
Scott JD, Forrest A, Feuerstein S, Fitzpatrick P, Schentag JJ. Factors associated with postoperative infection. Infect Control Hosp Epidemiol. 2001;22(6):
Yoshikawa TT. Epidemiology and unique aspects of aging and infectious diseases. Clin Infect Dis. 2000;30(6):931-3.
Cohen B, Choi YJ, Hyman S, Furuya EY, Neidell M, Larson E. Gender Differences in Risk of Bloodstream and Surgical Site Infections. J Gen Intern Med. 2013;28(10):
Martone WJ, Nichols RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis. 2001;33 Suppl 2:S67-8.