SLR - November 2022 - Kyle L Wachala, DPM
Title: Risk prediction model for deep surgical site infection (DSSI) following open reduction and internal fixation of displaced intra-articular calcaneal fractureReference: Lu K, Ma T, Yang C, Qu Q, Liu H. Risk prediction model for deep surgical site infection (DSSI) following open reduction and internal fixation of displaced intra- articular calcaneal fracture. Int Wound J. 2022;19 (3):656-665.
Level of Evidence: IV
Scientific Literature Review
Reviewed By: Kyle L Wachala, DPM
Residency Program: Christiana Care Health Services, Newark, DE
Podiatric Relevance: Deep surgical site infections (DSSI) are a serious surgical complication affecting anywhere from 2-15% of cases of displaced intra-articular calcaneal fractures, leading to further debridement or requiring removal of hardware. Therefore, it would be beneficial and cost-effective if we could identify independent risk factors leading to development of DSSI’s, and ultimately enact preventative measures to reduce this rate of infections.
Methods: This is a retrospective study that analyzed data from electronic medical records for patients over the age of 18 who underwent ORIF of acute closed calcaneal fractures in a single institution performed by 32 surgeons between January 2014 and December 2019 with a minimum of 12-month follow-up. Inclusion criteria were patients with complete follow-up data. A total of 1407 calcaneal fractures were surgically corrected within the study period, with 900 meeting inclusion criteria. Primary outcomes were evaluated using a risk prediction model identifying five risk factors for DSSI that were assigned a score based on magnitude of association with DSSI.
Results: Of the 900 patients included in this study, 2.7% developed a DSSI. Based on the risk prediction model identifying five risk factors for DSSI, patients with a score greater than 10 were at a statically significant risk of developing a DSSI, a score less than 7 almost ruled out the possibility of developing a DSSI with 100% sensitivity, and a score of 14 or higher was associated with an 8.1 times higher risk of developing a DSSI.
Conclusion: The authors of this study developed a risk prediction model by identifying five independent risk factors that are already well defined in the literature for development of a DSSI following ORIF of a closed intra-articular calcaneal fracture. They found statistically significant cut-off values for high and low risk of developing a DSSI. Overall, this article provides a useful tool to podiatric surgeons to identify which patients will be at a higher risk for development of a DSSI, and allows for consideration of prophylactic measures for prevention. However, further prospective and multicenter studies with a larger sample size are needed to verify this as an algorithm that can be used in clinical practice.