Does the Presence of a Pre-existing Open Wound Increase Complication Risk for Implant Procedures?
James Nie, BS, Sina Torabi, Henry Hsia, MD.
Yale School of Medicine, New Haven, CT, USA.
PURPOSE Despite limited evidence, a common belief in surgical practice is that patients should not undergo elective surgery until any open wounds heal because of the risk of seeding infection to the new surgical site. This is the first study to analyze postoperative complication rates for implants placed in the context of open wounds using the National Surgical Quality Improvement Program (NSQIP) database. METHODS We examined 30-day postoperative infections for breast, hip, knee, and spine implants using the 2008-2016 NSQIP database. Patients were excluded for missing data and propensity matched 1:10 for demographics and comorbidities to minimize confounders. Complication rates were assessed using Pearson chi-square tests.
RESULTS Of 350,819 patients who received breast, hip, knee, or spine implants in 2016, 1354 (0.39%) did so with an open wound (Table 1). After propensity score matching, the overall complication rate remained higher with the open-wound cohort (8.0% vs. 4.0%, P<0.001). Within 30 days of operation, patients in the open-wound cohort had significantly higher chances of >30 day post-operative stay, readmission, superficial surgical site infection, deep incisional surgical site infection, urinary tract infection, and sepsis.
CONCLUSIONS After adjusting for confounders, patients receiving surgical implants in the context of an open wound are at roughly double the risk of a surgical or medical complication and have increased risk of surgical site infection. Surgeons must weigh this risk against the risk of delaying treatment.
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