Published: 2018-06-23

Surgical site infections in orthopaedic surgeries: incidence and risk factors at tertiary care hospital of South India

Balakondaiah Koyagura, Harsha Kumar Koramutla, Bijju Ravindran, Jithendra Kandati


Background: Health care associated infections (HAI) are infections that patients acquire while receiving medical care and are one of the most adverse events during health care delivery. Among the HAI surgical site infections [SSI] ranks the second among surgery patients. The present study aims to identify the risk factors, incidence and also to set the strategies required to prevent the development of SSI in orthopaedic surgeries primarily.

Methods: A one year prospective study was conducted with a follow up of cases for one year post surgery in orthopaedic department. Cases that had undergone surgery were followed for development of SSI with a detailed demographic history, risk factor details after ethical committee approval. The data was analyzed using Statistical Package Social Sciences software 16 package (Chicago, USA).

Results: The incidence of SSI was 6.5% with males 61% and females 39% with mean age of 34.12±8.01 years. In our present significant statistical correlation was observed with SSI and associated risk factors which include, Increased age, BMI >25, administration of prophylactic antibiotic’s, multiple fractures (>2 in number), contaminated wound, presence of drain at surgical site and blood transfusion. Methicillin resistant Staphylococcus aureus was the most common isolated pathogen (48.4%).

Conclusions: The occurrence of SSI was higher in orthopaedic surgery than general surgeries. So our study clearly indicates that increased age, increased duration of surgery, increased hospitalization post-surgery, placement of drain at surgical site and blood transfusion are significant risk factors in development of SSI in orthopaedic surgeries.


Surgical site infections, Health care infections, Methicillin resistant Staphylococcus aureus, Pseudomonas

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Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure and patient risk index. Am J Epidemiol. 1991;91(3):152-7.

Maksimovic J, Markovíc-Denic L, Bumbasrevic M, Marinkovic J, Vlajinac H. Surgical site infections in orthopedics patients: prospective cohort study. Croat Med J. 2008;49(1):58-65.

Khan MS, Rehman S, Ali MA, Sultan B, Sultan S. Infection in Orthopedic Implant Surgery, Its Risk Factors and Outcome. J Ayub Med Coll Abbottabad. 2008;20(1):23-5.

Ercole FF, Chianca TCM, Duarte D, Starling CEF, Carneiro M. Surgical Site Infection in Patients Submitted to Orthopedic Surgery: The NNIS Risk Index and Risk Prediction. Rev. Latino-Am. Enfermagem. 2011;19(2):269-76.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606–8.

Skarzyńska J, Cienciała A, Madry R, Barucha P, Kwaśniak M, Wojewoda T, et al. Hospital infections in general surgery wards. Przegl Epidemiol. 2000;54:299-304.

Khan MS, Rehman S, Ali MA, Sultan B, Sultan S. Infection in Orthopedic Implant Surgery, Its Risk Factors and Outcome. J Ayub Med Coll Abbottabad. 2008;20(1):23-5.

Nichols RL. Preventing surgical site infections: a surgeon’s perspective. Emerg Inf Dis. 2001;7:220-4.

Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br. 2005;87(6):844-50.

Veeravagu A, Patil CG, Lad SP, Boakye M. Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine. 2009;34:1869-72.

Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Br. 2008;90:62-9.

Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70:3-10.‏

Lecuona M, Torres-Lana A, Delgado-Rodriguez M, Llorca J, Sierra A. Risk factors for surgical site infections diagnosed after hospital discharge. J Hosp Infect. 1998;39:71-4.

Casey AL, Elliott TSJ. Progress in the prevention of surgical site infection. Curr Opin Infect Dis. 2009;22:370-5.

Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality. J Am Coll Surg. 2009;208(5):931-7.

Pull ter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine. 2009;34(13):1422–8.

Kim DH, Spencer M, Davidson SM, Li L, Shaw JD, Gulczynski D, et al. Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. J Bone Joint Surg Am. 2010;92(9):1820-6.