Seasonal effect on the incidence of post-operative wound complications after trauma-related surgery of the foot, ankle a
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TRAUMA SURGERY
Seasonal effect on the incidence of post‑operative wound complications after trauma‑related surgery of the foot, ankle and lower leg Fay Ruth Katharina Sanders1 · Mirjam van’t Hul1 · Rosanne Maria Güzelleke Kistemaker1 · Tim Schepers1 Received: 7 October 2019 © The Author(s) 2020
Abstract Introduction Post-operative wound complications remain among the most common complications of orthopedic (trauma) surgery. Recently, studies have suggested environmental factors such as season to be of influence on wound complications. Patients operated in summer are reported to have more wound complications, compared to other seasons. The aim of this study was to identify if “seasonality” was a significant predictor for wound complications in this cohort of trauma-related foot/ankle procedures. Materials and methods This retrospective cohort study included all patients undergoing trauma-related surgery (e.g. fracture fixation, arthrodesis, implant removal) of the foot, ankle or lower leg. Procedures were performed at a Level 1 Trauma Center between September 2015 until March 2019. Potential risk factors/confounders were identified using univariate analysis. Procedures were divided into two groups: (1) performed in summer (June, July or August), (2) other seasons (September–May). The number of surgical wound complications (FRIs, SSIs or wound dehiscence) was compared between the two groups, corrected for confounders, using multivariate regression. Results A total of 599 procedures were included, mostly performed in the hindfoot (47.6%). Patients were on average 46 years old, and mostly male (60.8%). The total number of wound complications was 43 (7.2%). Age, alcohol abuse, open fracture and no tourniquet use were independent predicting factors. No difference in wound complications was found between summer and other seasons, neither in univariate analysis [4 (3.2%) vs 39 (8.2%), p = 0.086] nor when corrected for predicting factors as confounders (p = 0.096). Conclusions No seasonality could be identified in the rate of wound complications after trauma surgery of the lower leg, ankle and foot in this cohort. This lack of effect might result from the temperate climate of this cohort. Larger temperature and precipitation differences may influence wound complications to a larger extent. However, previous studies suggesting seasonality in wound complications might also be based on coincidence. Keywords Seasonality · Wound complication · Surgical site infection · Fracture related infection · Foot · Ankle · Trauma surgery
Introduction The incidence of surgical site infections (SSIs) following orthopedic trauma surgery of foot and ankle has been reported as ranging from 0 to 9.4% [1]. In complex foot injuries, this percentage can even increase up to 25% [2]. This * Tim Schepers [email protected] 1
Amsterdam UMC, University of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
incidence is much higher compared to most other surgical procedures and is most likely related to the thi
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