Surgical Site Infections in Orthopaedic Trauma Patients: Pre-Operative Antibiotic Administration at the Ward Versus the Operating Room. A Retrospective Cohort Study
Keywords:
Preoperative antibiotic prophylaxis, Time-to-incision, Risk factors for surgical site infection, General hospital setting, Closed fracture surgeryAbstract
Objective: To determine the incidence of surgical site infection (SSI) in patients with closed upper and lower extremity fractures, to compare SSI incidence and time-to-incision between preoperative antibiotic administration at the ward and in the operating room, and to identify factors associated with SSI in a general hospital setting
Methods: A retrospective cohort study was conducted among patients who underwent surgery for closed upper and lower extremity fractures at Banpong Hospital between January 2023 and December 2024. A total of 315 patients were included, comprising 281 patients in the ward group and 34 patients in the operating room group. Descriptive statistics were used to summarize patient characteristics. Comparative analyses were performed using independent t test, Mann-Whitney U test, chi-square test, and Fisher’s exact test, and Univariable logistic regression analysis was applied to identify factors associated with SSI.
Results: The overall incidence of SSI was 3.8%. There was no statistically significant difference in SSI incidence between the ward group (3.6%) and the operating room (on-table) group (5.9%) (p = .626). The ward group had a significantly longer time-to-incision compared with the operating room (on-table) group (median 55 vs. 11 minutes; p < .001). Factors significantly associated with SSI included longer duration of surgery (OR = 1.0104; 95% confidence interval 1.0003–1.0206; p-value = .045) and the use of bone substitute (OR = 9.9000; 95% confidence interval 1.7729–55.2812; p-value = .009).
Conclusion: Preoperative antibiotic administration at the ward in Banpong Hospital was performed within an appropriate time frame according to clinical practice guidelines and was not associated with a higher incidence of SSI compared with administration in the operating room.
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