Incidence of Acute and Subacute Deep Infection in Patients Undergoing Ankle Fracture Open Reduction with Internal Fixation and Associated Risk Factors.

Abstract

Surgical site infections are estimated to occur in 1.4% - 5.5% of all patients who undergo ankle fracture open reduction with internal fixation. While other studies only report on infection rates after ankle ORIF, this study evaluated the association between infection rates and operative factors. We performed a retrospective cohort study of adults at Kaiser Permanente Northern California who underwent ankle fracture ORIF between January 1, 2010 and September 30, 2022. Patients were followed up to 6 weeks after initial surgery for return to the operating room, and charts were reviewed for deep SSI. We utilized 6 weeks return to the operating room to identify patients with acute and subacute deep SSI. Among the 9,749 eligible patients who underwent ankle fracture ORIF, 33 (0.3%) returned to the operating room within 6 weeks, 3 of whom returned within 2 weeks. The rate of return to operating room was higher in patients with incision time greater than 120 minutes (OR 5.16, 95% CI 2.59-10.26; p<0.001), with tourniquet time of 90-150 minutes (OR 4.30, 95% CI 1.909.71; p<0.0001), with immunocompromised status (OR 14.19, 95% CI 3.3061.12; p<0.0001), and with hemoglobin A1c greater than 8.0% (OR 4.12, 95% CI 1.40-12.12; p=0.01). We concluded that decreasing operative time and tourniquet time are important modifiable variables in the prevention of deep SSI in ankle fracture patients. Body mass index, Ioban use, and antibiotic powder use were not associated with the development of deep SSI. Level 3: This retrospective cohort study holds a designation based on the analysis of patients who underwent ankle fracture ORIF.