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. 2022 Jun;10(6):514-524.
doi: 10.22038/ABJS.2021.53838.2688.

Implant Removal Due to Infection After Open Reduction and Internal Fixation: Trends and Predictors

Alec S Kellish  1 , Alisina Shahi  2 , Julio A Rodriguez Jr  1 , Kudret Usmani  2 , Michael Boniello  2 , Ali Oliashirazi  3 , Kenneth Graf  2 , Henry Dolch  2 , David Fuller  2 , Rakesh P Mashru  2
Affiliations

Implant Removal Due to Infection After Open Reduction and Internal Fixation: Trends and Predictors

Alec S Kellish et al. Arch Bone Jt Surg. 2022 Jun.

Abstract

Background: Implant removal due to infection is one of the major causes failure following open reduction and internal fixation (ORIF). The aim of this study was to determine trends and predictors of infection-related implant removal following ORIF of extremities using a nationally representative database.

Methods: Nationwide Inpatient Sample data from 2006 to 2017 was used to identify cases of ORIF following upper and lower extremity fractures, as well as cases that underwent infection-related implant removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related implant removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year.

Results: For all ORIF procedures, the highest rate of implant removal due to infection was the phalanges/hand (5.61%), phalanges/foot (5.08%), and the radius/ulna (4.85%). Implant removal rates due to infection decreased in all fractures except radial/ulnar fractures. Tarsal/metatarsal fractures (odds ratio (OR)=1.45, 95% confidence interval (CI): 1.02-2.05), and tibial fractures (OR=1.82, 95% CI: 1.45-2.28) were identified as independent predictors of infection-related implant removal. Male gender (OR=1.67, 95% CI: 1.49-1.87), Obesity (OR=1.85, 95% CI: 1.34-2.54), diabetes mellitus with chronic complications (OR=1.69, 95% CI: 1.13-2.54, P<0.05), deficiency anemia (OR=1.59, 95% CI: 1.14-2.22) were patient factors that were associated with increased infection-related removals. Removal of implant due to infection had a higher total charge associated with the episode of care (mean: $166,041) than non-infection related implant removal (mean: $133,110).

Conclusion: Implant removal rates due to infection decreased in all fractures except radial/ulnar fractures. Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related implant removal. The study identified some risk factors for implant related infection following ORIF, such as diabetes, obesity, and anemia, that should be studied further to implement strategies to reduce rate of infection following ORIF.

Keywords: Fracture; Implant removal; Infection; Infection-related implant removal; Septic hardware.

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Conflict of interest statement

No funding was received for this research study. We have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Trend in ORIF overall in NIS Data
Figure 2
Figure 2
Trend in Implant removal by body region
Figure 3
Figure 3
Trend in Implant Removal due to infection by body region
Figure 4
Figure 4
Implant Removals due to Infection
Figure 5
Figure 5
Predictors of infection related implant removal
Figure 6
Figure 6
Average Length of Stay following Aseptic versus Septic Implant Removal
Figure 7
Figure 7
Hospital Charges following Aseptic versus Septic Implant Removal
See this image and copyright information in PMC

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