Administrative Risk Factors
• There was no significant difference in risk of SSI when being treated as an inpatient or outpatient.
Prevention of Surgical Site Infection After Major Extremity Trauma (2022)
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: ASES, POSNA, AOFAS, IDSA, OTA

Rationale

Two high (Driesman 2017, Molina 2015) and one moderate quality study (Morris 2013) investigated the effect of race and socio-economic status (SES) on SSI, and these demonstrated that race and SES do not alter one's risk for SSI. It is beyond the scope of this PICO to discuss the effect of race and SES on other surgical outcomes.

One moderate (Backes 2014) and one low quality study (Bergin 2012) discussed the effect of inpatient and outpatient treatment of major extremity trauma as it relates to SSI, and both demonstrated that there was no significant difference in risk of SSI between these two groups.

Benefits & Harms

There are no specific harms to be expected with implementing this recommendation. 

Outcome Importance

While there are many other factors that affect the risk for surgical site infection, this allows for discussion with patients that their demographics do not seem to significantly influence their risk of infection. 

Cost Effectiveness/Resource Utilization

This recommendation requires minimal resources and there is no cost associated with implementation.

Acceptability

While there is excellent evidence that patient demographics affect other measurable peri and post-operative outcomes, there is no evidence that it specifically affects their risk of surgical site infection in major extremity trauma. 

Feasibility

Implementation of this PICO is quite feasible. However, again, patients should be counseled that this recommendation specifically addresses surgical site infection alone and does not address other outcome measures. 

 Future Research

There is minimal evidence to better inform surgeons regarding the impact of external risk factors for surgical site infection. Furthermore, many of the studies were specific to certain fracture types and therefore could not be generalized to other types of fracture. Future trauma registries may be able to address these issues more definitively, if they include these particular types of external factors in their data sets.