N. R. Bruce1, W. C. Beck1, J. R. Taylor1, M. K. Kimbrough1, J. Jensen1, M. J. Sutherland1, R. D. Robertson1, K. W. Sexton1 1University Of Arkansas For Medical Sciences,Department Of Surgery,Little Rock, AR, USA
Introduction:
Our state contains only one level 1 trauma center and is a rural sate. This study sought to categorize the rate of surgical site infection (SSI) in trauma surgery patients with orthopedic injuries and identify correlating factors to detect possible areas for performance improvement within our trauma system.
Methods:
IRB approval was obtained and de-identified patient information was provided by the local trauma registry for all patients admitted at a single institution with fractures from April 2014 until April 2015. Initial sample included 520 patients, 1 patient was excluded due to thermal injury and 9 due to mortality. Fractures were categorized based on anatomic region and based on treatment by an orthopedist with fellowship training in trauma. Factors examined included patient demographics, number of trips to operating room, and presentation from scene status. Statistical analyses were performed using JMP Pro 13.1.0 (Cary, NC) with significance set at p<.05.
Results:
Final sample size consisted of 510 patients; 31% were women, 55% arrived from the scene, 70% arrived via ground, 74% were Caucasian, and 20% were African American. Lower leg shaft fractures (40%), followed by femoral shaft fractures (22%) and forearm fractures (14%) were the most common injuries. Of these patients 62% were managed initially by orthopedic surgeons with fellowship training in trauma. Bivariate analysis revealed that there was no difference in bones fractured between those with SSI and those without. SSI patients were older (47.8 ± 2.8 years compared to 42.6 ± 0.8 years), had less trips to the operating room (2.1 ± 1.4 vs 3.2 ± 2.8), and were more likely to be transferred from an outside hospital (75%). There was no difference with infection rates comparing orthopedists with and without fellowship training in trauma orthopedics.
Conclusions:
Surgical site infections after orthopedic trauma are a significant burden. Our data suggests that further research and targets for improvement should be across a trauma system to provide more expedient access to definitive care, as there is a higher risk for SSI in patients transferred from another hospital.