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Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction

Published online by Cambridge University Press:  31 March 2016

Michael V. Murphy
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Dongyi (Tony) Du
Affiliation:
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
Wei Hua
Affiliation:
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
Karoll J. Cortez
Affiliation:
Office of Cellular, Tissue and Gene Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
Melissa G. Butler
Affiliation:
Center for Clinical & Outcomes Research, Kaiser Permanentema, Atlanta, Georgia
Robert L. Davis
Affiliation:
Center for Clinical & Outcomes Research, Kaiser Permanentema, Atlanta, Georgia
Thomas A. DeCoster
Affiliation:
Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, New Mexico
Laura Johnson
Affiliation:
Center for Health Services Research, Henry Ford Health System, Detroit, Michigan
Lingling Li
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Cynthia Nakasato
Affiliation:
Center for Health Research, Kaiser Permanente Hawaii, Honolulu, Hawaii
James D. Nordin
Affiliation:
HealthPartners Institute for Education and Research, Minneapolis, Minnesota
Mayur Ramesh
Affiliation:
Center for Health Services Research, Henry Ford Health System, Detroit, Michigan
Michael Schum
Affiliation:
Health Services Research Division, LCF Research, Albuquerque, New Mexico
Ann Von Worley
Affiliation:
Health Services Research Division, LCF Research, Albuquerque, New Mexico
Craig Zinderman
Affiliation:
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
Richard Platt
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Corresponding

Abstract

OBJECTIVE

To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions.

DESIGN

Retrospective cohort study.

SETTING AND POPULATION

Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008.

METHODS

We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients’ demographic characteristics, comorbidities, and choice of graft.

RESULTS

On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%–1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%–3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8–12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3–4.8).

CONCLUSIONS

The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients.

Infect Control Hosp Epidemiol 2016;37:827–833

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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