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Comorbidities associated with increased likelihood of postoperative surgical site infection in patients treated for hand or finger fracture and/or dislocations
Matthew D Rich, MD1, Thomas J Sorenson, BS1, Annika Deitermann, BS1, Warren Schubert, MD2, Christopher J Hillard, MD3 and Ashish Y Mahajan, MD4, (1)University of Minnesota, Minneapolis, MN, (2)Department of Plastic Surgery and Hand Surgery, Regions Hospital, St Paul, MN, (3)Regions Hospital, St Paul, MN, (4)Regions Hospital, St. Paul, MN

Introduction Patient comorbidities are well understood to affect surgical outcomes in many settings. Our purpose was to determine the relationship between common patient preoperative comorbidities and subsequent incidence of postoperative surgical site infections (SSIs) in a large population of patients being treated for hand and finger fractures and/or dislocations.
Materials and Methods We report a cross-sectional study of consecutive patients reported to the American College of Surgeons (ACS) National Safety and Quality Improvement Program (NSQIP) from January 1, 2015 to December 31, 2019. Patients were included in our study if they were treated by open or percutaneous fixation for any hand or finger fracture and/or dislocation. Predictor variables were smoking status, diabetes mellitus status, and obesity (BMI > 30) status. Primary outcome was incidence of postoperative SSI.
Results There were a total of 9,671 patients included in our study, and 162 (162/9,671; 1.68%) patients experienced postoperative SSI. Of these, 59 (59/162; 36.4%) patients were smokers, seven (7/162; 4.3%) patients had diabetes mellitus, and 55 (55/156; 35.3%) patients were obese. Overall, patients experienced greater odds of sustaining a postoperative SSI if they were a smoker (Odds Ratio [OR]: 1.45, 95% Confidence Interval [CI]: 1.05 - 2.00, p = .0245), diabetic (OR: 2.33, 95% CI: 1.08 - 5.03, p = .0319), and obese (OR: 1.40, 95% CI: 1.00 - 1.94, p = .0488) compared to non-smokers, non-diabetics, and non-obese, respectively. Considering only open fixation modality, patients experienced significantly greater odds of sustaining postoperative SSI if they were a diabetic (OR: 3.11, 95% CI: 1.34 - 7.21, p = .0081) compared to non-diabetic. Considering only percutaneous fixation modality, patients experienced significantly greater odds of sustaining postoperative SSI if they were a smoker (OR: 2.24, 95% CI: 1.27 - 3.96, p = .0056) compared to non-smoker.
Conclusions Common American preoperative comorbidities, including smoking status, diabetes mellitus, and obesity, increase the likelihood of postoperative complication in patients with hand and finger fractures and/or dislocations undergoing surgical treatment. Further investigation into the different relationship of these comorbidities between open and closed fractures will be valuable.


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