Comparison of Patient Demographics and Risk of Surgical Site Infections Following Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures: A Nationwide Analysis of a Private Payor

Patrick Nian; Faisal Elali; Lucas C Voyvodic; Ariel Rodriguez; Mitchell K Ng; Amr A Abdelgawad; Afshin E Razi

doi:10.1053/j.jfas.2024.04.002

Comparison of Patient Demographics and Risk of Surgical Site Infections Following Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures: A Nationwide Analysis of a Private Payor

J Foot Ankle Surg. 2024 Apr 26:S1067-2516(24)00071-1. doi: 10.1053/j.jfas.2024.04.002. Online ahead of print.

Authors

Patrick Nian¹, Faisal Elali¹, Lucas C Voyvodic¹, Ariel Rodriguez², Mitchell K Ng³, Amr A Abdelgawad³, Afshin E Razi³

Affiliations

¹ Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY; State University of New York (SUNY) Downstate, School of Medicine, Brooklyn, New York, NY.
² Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY. Electronic address: ArielR418@Gmail.com.
³ Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York, NY.

PMID: 38679410
DOI: 10.1053/j.jfas.2024.04.002

Abstract

Surgical site infections (SSIs) are a notable complication following open reduction and internal fixation (ORIF) for ankle fractures. The purpose of this study was to (1) compare baseline demographics of patients who did and did not develop SSIs within 90 days following ORIF for trimalleolar ankle fractures and (2) identify risk factors associated with SSIs in this setting. A retrospective analysis from 2010 to 2020 was completed using a national administrative database. The study group consisted of patients who underwent ORIF for trimalleolar ankle fractures and developed SSIs within 90 days postoperatively. Patients without SSIs served as the comparison cohort. Baseline demographics of the two cohorts were compared utilizing Pearson's Chi-Square Analyses. A multivariate binomial logistic regression model determined the association of various comorbidities on developing SSIs in this setting. Out of a total sample of 22,118 patients, 1,000 individuals (4.52%) developed SSIs. The study revealed that the SSI cohort exhibited a greater burden of comorbidities, as evidenced by significant differences in various individual comorbidities and average Elixhauser-Comorbidity Indices scores. The most strongly associated risk factors for the development of SSIs following ORIF for trimalleolar ankle fractures were peripheral vascular disease (OR: 1.53, p<0.0001), diabetes mellitus (OR: 1.26, p=0.0010), iron deficiency anemia (OR: 1.24, p=0.0010), male sex (OR: 1.22, p=0.0010), and tobacco use (OR: 1.15, p=0.0010). This study identified several patient risk factors that were associated with developing SSIs after ORIF for trimalleolar ankle fractures, recognizing potential patient-directed interventions that may reduce the rate of SSIs in this setting.

Keywords: Open Reduction Internal Fixation, Outcomes, Medical Comorbidities, Patient Optimization; Risk Factors; Surgical Site Infection; Trimalleolar Ankle Fracture.