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. 2017 Jun 13;1(3):e022.
doi: 10.5435/JAAOSGlobal-D-17-00022. eCollection 2017 Jun.

Surgical Wound Classification and Surgical Site Infections in the Orthopaedic Patient

Ikemefuna Onyekwelu  1 , Ramakanth Yakkanti  1 , Lauren Protzer  1 , Christina M Pinkston  1 , Cody Tucker  1 , David Seligson  1
Affiliations

Surgical Wound Classification and Surgical Site Infections in the Orthopaedic Patient

Ikemefuna Onyekwelu et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Introduction: The Centers for Disease Control and Prevention created a surgical wound classification system (SWC: I, clean; II, clean/contaminated; III, contaminated; and IV, dirty) to preemptively identify patients at risk of surgical site infection (SSI). The validity of this system is yet to be demonstrated in orthopaedic surgery. We hypothesize a poor association between the SWC and the rate of subsequent SSI in orthopaedic trauma cases.

Methods: Nine hundred fifty-six orthopaedic cases were reviewed. Wounds were risk stratified intraoperatively using the SWC grades (I-IV). SSI was diagnosed clinically or with objective markers. The SWC was compared with SSI rates using a Fisher exact test. Significance was set at P < 0.05.

Results: Four hundred patients met the selection criteria. The rate of infection was not significantly different across the SWC grades (P = 0.270). There was a significantly higher risk of SSI among patients with diabetes (P = 0.028).

Conclusions: The Centers for Disease Control and Prevention SWC showed poor utility in predicting and risk stratifying postoperative SSIs in orthopaedic surgical cases.

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Conflict of interest statement

No commercial funding or grants were used for this study. Dr. Seligson or an immediate family member serves as a board member, owner, officer, or committee member of the Kuntscher Society; has received research or institutional support from Pacira Pharma; and serves as a paid consultant to Stryker. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this chapter: Dr. Onyekwelu, Mr. Yakkanti, Ms. Protzer, Ms. Pinkston, and Mr. Tucker.

Figures

Figure 1
Figure 1
Flow diagram of patient selection and review process
Figure 2
Figure 2
CDC class versus SSI rate per class. There was no significant difference in the rate of infection across the CDC wound classes (P = 0.27); this trend remained true when CDC wound classifications III (contaminated) and IV (dirty/infected) were combined (P = 0.15). CDC = Centers for Disease Control and Prevention, SSI = surgical site infection.
Figure 3
Figure 3
CDC classification versus percent cases/SSIs per class. Percentage of cases/SSIs in each class. CDC = Centers for Disease Control and Prevention, SSI = surgical site infection
Figure 4
Figure 4
Extremity versus percent SSI. Patients with lower extremity injuries had a significantly higher incidence of SSI (20 of 197) compared with upper extremity injuries (3 of 155) or pelvic/sacrum injuries (4 of 48) (P = 0.002). CDC = Centers for Disease Control and Prevention, SSI = surgical site infection
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References

    1. References printed in bold type are those published within the past 5 years.

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