1. Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes
- Author
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Ida Leah Gitajn, MD, MS, Paul M. Werth, PhD, Anthony R. Carlini, MS, Michael J. Bosse, MD, Joshua L. Gary, MD, Reza Firoozabadi, MD, MA, William Obremskey, MD, MPH, Todd O. McKinley, MD, Renan C. Castillo, PhD, Robert V. O’Toole, MD, and METRC, Edward R. Westrick, Eben A. Carroll, James Brett Goodman, Martha B. Holden, Anna N. Miller, Amanda Spraggs-Hughes, PhD, Michael L. Brennan, Paul Tornetta, III, Michael J. Weaver, Marilyn Heng, Patrick M. Osborn, Jessica C. Rivera, Clinton K. Murray, Joseph E. Kimmel, Charles Moon, Joseph R. Hsu, Madhav A. Karunakar, Laurence B. Kempton, Rachel B. Seymour, Stephen H. Sims, Christine Churchill, Rachel M. Reilly, Robert D. Zura, Cameron Howes, Hassan Mir, Emily A. Wagstrom, Brian Mullis, Jeffrey O. Anglen, Leilani S. Mullis, Karl D. Shively, Greg E. Gaski, Roman M. Natoli, Anthony Sorkin, Walter Virkus, Robert A. Hymes, Michael A. Holzman, A. Stephen Malekzadeh, Jeff E. Schulman, Cary C. Schwartzbach, Olivia C. Lee, Peter C. Krause, Massimo "Max" Morandi, Andrew Choo, John W. Munz, Sterling Boutte, Matthew C. Galpin, H. Michael Frisch, Adam M. Kaufman, C. Michael LeCroy, Christopher S. Smith, Alec C. Stall, Andrea Horne, Jason W. Nascone, Nathan N. O'Hara, Ebrahim Paryavi, Marcus F. Sciadini, Yasmin Degani, Andrea L. Howe, Roman Hayda, Andrew R. Evans, Debra L. Sietsema, Stanislaw P. Stawicki, Thomas Wojda, Michael J. Gardner, Julius A. Bishop, Saqib Rehman, Cyrus Caroom, Elizabeth Sheridan, Theodore Miclau, Saam Morshed, Thomas F. Higgins, Justin M. Haller, Paul E. Matuszewski, Arun Aneja, Raymond D. Wright, Jr., Patrick F. Bergin, Eldrin Bhanat, Matt L. Graves, John Morellato, Clay A. Spitler, David Teague, William Ertl, Jaimo Ahn, Patrick Hesketh, Gele B. Moloney, John C. Weinlein, Boris A. Zelle, Animesh Agarwal, Ravi A. Karia, Ashoke Sathy, Drew T. Sanders, David B. Weiss, Seth R. Yarboro, Veronica Lester-Ballard, Eric D. McVey, Arman Dagal, Michael Githens, Conor Kleweno, Julie Agel, Paul S. Whiting, Natasha M. Simske, Alexander B. Siy, Basem Attum, Eduardo Burgos, Vamshi Gajari, Andres Rodriguez-Buitrago, Manish Sethi, Rajesh R. Tummuru, Jean-Claude G. D'Alleyrand, Lauren E. Allen, Susan C. Collins, Yanjie Huang, and Tara J. Taylor
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Background:. Fracture-related infection is one of the most challenging complications in orthopaedic trauma surgery. However, the effect of infection on functional and pain-related outcomes has not been well established. The aims of this study were to evaluate functional recovery for patients with fracture and a deep surgical site infection compared with patients with fracture without infection and to evaluate whether pain severity, social support, and preinjury mental health have a moderating effect on the magnitude and direction of the relationship between deep surgical site infection and functional recovery. Methods:. This is a secondary retrospective cohort study using prospectively collected data from the VANCO trial (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) and the OXYGEN (Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery) trial. In this study, 2,116 patients with tibial plateau, pilon, or calcaneal fractures at high risk for infection were included. Patients were divided into cohorts of patients who experienced a deep surgical site infection and those who did not. The primary outcome measure was the functional outcome using the Veterans RAND 12-Item Health Survey (VR-12). Results:. After controlling for covariates, deep surgical site infection was independently associated with functional outcome, with a 3.3-point reduction in the VR-12 Physical Component Score, and pain severity was independently associated with functional outcome, with a 2.5-point reduction in the VR-12 Physical Component Score. Furthermore, the Brief Pain Inventory pain severity demonstrated an important moderating effect on the relationship between infection and functional outcome. In patients with lower pain scores, infection had a large negative impact on functional outcome, whereas, in patients with higher pain scores, infection had no significant impact on functional outcome. Furthermore, the functional outcome in the entire cohort remains at only 61% of baseline. Conclusions:. This study documents the negative impact of postoperative infection on functional recovery after injury, as well as the novel finding of pain severity as an important moderating factor. This study emphasizes not only the importance of developing effective interventions designed to reduce postoperative infection, but also the role that factors that moderate pain severity plays in limiting recovery of physical function. Level of evidence:. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2024
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