Conectar
This study was designed to identify risk factors for wound complications including surgical site infection (SSI) and wound healing issues following open reduction and internal fixation (ORIF) of ankle fractures. A retrospective analysis of individuals with ankle fractures treated with ORIF was undertaken. Study subjects were divided into a wound complications (WC) group and a no wound complication (NWC) group. The WC group was further divided into an SSI group and wound healing issues group. Twenty-one potential risk factors associated with wound complications after ORIF were tracked. Uni- and multivariate binary logistical regression analyses were used to identify risk factors associated with wound complications, ISS and wound healing issues. In total, 613 individuals, who had undergone surgery for ankle fractures formed the study cohort. The incidence of postoperative wound complications was 10.3% (63 cases), including 5.2% of SSI (32 cases) and 5.1% of wound healing issues (31 cases). The independent risk factors for wound complications were age 65 years or older, preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture, fewer than seven cases per year in surgical volume, and attending surgeon level. The independent risk factors for SSI were age 65 years or older, preoperative serum albumin level below 35 g/L, open fracture and fewer than seven cases per year in surgical volume. The independent risk factors for wound healing issues were preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture and attending surgeon level. Herein we found both factors inherent to the injury and individual and those pertaining to the surgical team affected the frequency of wound complications after ORIF of ankle fractures. Specifically, advanced age and low surgical volume were associated with a greater risk of SSI. Peripheral neuropathy and the low expertise level on the part of the surgeon were associated with a greater risk of wound healing issues. Hypoproteinaemia and open fracture were both associated with a greater risk of both SSI and wound healing issues.
Post-joint arthroplasty infections, especially surgical site infections (SSI) and periprosthetic joint infections (PJI), significantly impact patient outcomes. The potential influence of malnutrition on these postoperative complications remains a crucial concern for clinicians. Adhering to PRISMA guidelines, we performed a systematic review and meta-analysis using four databases up to 19 July 2023. We sought studies on joint replacements, focusing on malnutrition as an SSI risk factor. The malnutrition criteria were defined by specific laboratory parameters. Two independent reviewers undertook data extraction and quality assessment, with discrepancies resolved through consensus or third-party review. Studies were evaluated for methodological quality using the Newcastle-Ottawa Scale (NOS). For statistical analyses, heterogeneity was assessed using the I 2 statistic, and both fixed and random-effects models were employed based on heterogeneity levels, utilizing Stata software (version 17). Significant heterogeneity was present among studies examining the relationship between malnutrition and SSI (I 2 = 59.5%, p = 0.03%). Employing the random-effects model, results indicated that malnourished individuals were approximately 2.63 times more likely to develop SSI post-operation. Further exploration into the association between malnutrition and PJI, from seven pertinent studies, also revealed an elevated risk (OR = 2.59, 95% CI: 1.79–3.39). Sensitivity analyses confirmed the robustness of these findings, and publication bias assessments supported the validity of the included studies. Malnutrition robustly correlates with an increased risk of both SSI and PJI following total joint arthroplasty. Emphasizing preoperative nutritional assessments and intervention strategies may offer a promising avenue to enhance patient outcomes and reduce postoperative complications.
FreshRSS 