Risk Factors for Surgical Site Infection in Distal Radius Fracture Surgery

PURPOSE: Surgical site infections (SSI) after distal radius surgery can introduce substantial morbidity and additional direct and indirect costs. The clearest risk factors for SSI are the use of externalized Kirschner wires (K-wires) or external fixation (ex-fix). The roles of other potential risk factors such as open injuries, diabetes mellitus, and tobacco use are less clear. The purpose of this study was to identify independent risk factors for SSI in distal radius surgery. METHODS: A retrospective study of 541 operative distal radius fractures over a 5-year period was performed. Potential risk factors for infection included surgery duration, externalized K-wires or ex-fix, diabetes mellitus, uncontrolled diabetes defined as a HgBA1c >7 documented within a 90-day perioperative period, open fracture, tobacco use, osteoporosis, gender, and age. A screening bivariate logistic regression was performed, followed by a multiple logistic regression of the selected independent variables, with SSI as the dependent variable. A p-value of <0.05 was considered statistically significant. RESULTS: Twenty fractures (3.7%) were complicated by post-operative SSI, and 521 (96.3%) were not. Uncontrolled diabetes with HgA1c >7 (OR = 7.83, p=0.002), the presence of an ex-fix or k-wires (OR =3.73, p=0.007), and tobacco use (OR=3.79, p=0.007) were significant independent predictors of SSI. Of note, while uncontrolled diabetes was an independent risk factor, the diagnosis of diabetes alone was not. CONCLUSIONS: Previously identified risk factors for SSI after distal radius surgery including the presence of externalized K-wires or ex-fix were confirmed in this study. Additionally, this study demonstrates that tobacco use and uncontrolled diabetes (HgA1c >7) are both independent risks factors for SSI. Notably, the presence of diabetes alone was not an independent risk factor, highlighting the importance of glycemic control. LEVEL OF EVIDENCE: Level III