Risk Factors For Deep Surgical Site Infections Following Orthopaedic Trauma Surgery

Background: Surgical site infections (SSIs) represent a major concern in orthopedic surgery, leading to prolonged hospital stays, increased healthcare costs, and potentially life-threatening complications. SSIs are particularly common in patients with severe fractures, such as those classified by the Cauchoix grading system, where the risk of infection is heightened due to the complexity of the injury and the surgical intervention required. Factors such as nutritional status, diabetes, smoking, and the use of external fixators contribute to the development of SSIs. This study, conducted at Bacha Khan Medical Complex, Mardan, seeks to identify the clinical and laboratory markers that can predict SSIs in patients undergoing orthopedic fracture management, thereby helping to reduce the incidence and severity of these infections. Method: This prospective cohort study was conducted from January 2024 to December 2024 at the orthopedic ward of Bacha Khan Medical Complex, Mardan. A total of 207 patients who underwent surgery for fractures were included in the study. Inclusion criteria were patients over the age of 18 years undergoing orthopedic fracture surgery. Exclusion criteria included patients with pre-existing infections, immunocompromised conditions, or those who underwent emergency surgeries. Data was collected on patient demographics, fracture grade (Cauchoix classification), laboratory markers (hemoglobin, lactate levels, creatinine, glycemia, and arterial oxygen levels), and the use of external fixators. Statistical analysis was performed using SPSS, and predictive models for SSI development were created based on these parameters. Result: Fractures classified as Cauchoix grade 3 were associated with a higher incidence of SSIs (47%). Polymicrobial infections were found in 64% of the SSI cases, with gram-positive cocci, including Staphylococcus aureus, being the most common pathogens (72%). A predictive model with an AUC of 0.80 and a negative predictive value of 95.9% was developed. The significant risk factors for SSI development included low hemoglobin, maximum lactate levels, minimum arterial oxygen levels, and high glycemia levels. The use of external fixators was linked to a higher risk of infection in 38% of the SSI cases. Conclusion: Cauchoix grade 3, and laboratory markers such as lactate levels and glycemia were strongly associated with an increased risk of infection. The developed predictive model with high sensitivity and specificity could aid in early identification of at-risk patients, allowing for targeted preventive measures and potentially reducing the incidence of SSIs in orthopedic trauma care. Future research should focus on refining this model and assessing the effectiveness of preventive strategies based on these predictive factors.