Will My Fracture Surgery Get Infected? Evidence-based Risk Factors

Postoperative surgical site infection (SSI) is a growing problem in orthopedic trauma surgery. Consequently, emphasis on identifying risk factors has increased. We present a narrative review of the literature to facilitate evidence-based risk stratification for patients undergoing fracture fixation. Risk factors, including diabetes, hyperglycemia, end-stage renal disease requiring hemodialysis, human immunodeficiency virus, acquired immunodeficiency syndrome, hepatitis C, and alcohol abuse, have consistently been shown to increase infection risk in orthopedic surgery. Other risk factors, including smoking, obesity, and the use of immunomodulatory medications, have been shown to have varying direct impact on postoperative SSI depending on the study and the specific fractures examined. Factors such as increasing age, male sex, and ballistic injuries have very limited data implicating them in increasing risk of postoperative SSI. Fracture characteristics, including fracture region, open injury, compartment syndrome, and the need for flap coverage, increase the risk of SSI to varying degrees. Interventions such as blood transfusion and angioembolization can also increase the risk of infection. Although data on many of the risk factors for infection in orthopedic trauma are conflicting and larger scale studies are needed, an understanding of the available research is helpful to guide clinicians as they inform patients and attempt to optimize care.