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Published in: International Orthopaedics 4/2013

01-04-2013 | Original Paper

Smoking is a risk factor of organ/space surgical site infection in orthopaedic surgery with implant materials

Authors: François Durand, Philippe Berthelot, Celine Cazorla, Frederic Farizon, Frederic Lucht

Published in: International Orthopaedics | Issue 4/2013

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Abstract

Purpose

In recent guidelines, smoking is reported as a factor increasing the risk of surgical site infection (SSI). The accurate analysis of the literature shows that this recommendation relies on low level of evidence in orthopaedic surgery with material implantation (arthroplasty components or implants for internal fixation). This study aimed to assess the attributable risk of smoking on organ/space SSI in orthopaedic surgery with implants.

Methods

Risk factors of organ/space SSI were studied in a prospective cohort including 3,908 patients from June 2003 to December 2006.

Results

Smoking was found as a significant risk factor for organ/space SSI. We also observed a significant difference between smokers and non-smokers for surgical wound complications (hematoma, discharge or wound dehiscence) during the period between surgical procedure and discharge from hospital.

Conclusion

This is the first large prospective report of a significant association between smoking and organ/space SSI in orthopaedic surgery with implants.
Literature
1.
go back to reference Anderson DJ, Kaye KS, Classen D et al (2008) Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 29:S51–S61PubMedCrossRef Anderson DJ, Kaye KS, Classen D et al (2008) Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 29:S51–S61PubMedCrossRef
2.
go back to reference Mangram AJ, Horan TC, Pearson ML et al (1999) Guidelines for prevention of surgical site infection. Hospital infection control practices advisory committee. Infect Contr Hosp Epidemiol 20:250–278CrossRef Mangram AJ, Horan TC, Pearson ML et al (1999) Guidelines for prevention of surgical site infection. Hospital infection control practices advisory committee. Infect Contr Hosp Epidemiol 20:250–278CrossRef
3.
go back to reference Kanafani ZA, Arduino JM, Muhlbaier LH et al (2009) Incidence of and preoperative risk factors for Staphylococcus aureus bacteraemia and chest wound infection after cardiac surgery. Infect Contr Hosp Epidemiol 30:242–248CrossRef Kanafani ZA, Arduino JM, Muhlbaier LH et al (2009) Incidence of and preoperative risk factors for Staphylococcus aureus bacteraemia and chest wound infection after cardiac surgery. Infect Contr Hosp Epidemiol 30:242–248CrossRef
4.
go back to reference Rightmire E, Zurakowski D, Vrahas M (2008) Acute infections after fracture repair: management with hardware in place. Clin Orthop Relat Res 466:466–472PubMedCrossRef Rightmire E, Zurakowski D, Vrahas M (2008) Acute infections after fracture repair: management with hardware in place. Clin Orthop Relat Res 466:466–472PubMedCrossRef
5.
go back to reference Thangarajah T, Prasad PS, Narayan B (2009) Surgical site infections following open reduction and internal fixation of ankle fractures. Open Orthop J 22:56–60CrossRef Thangarajah T, Prasad PS, Narayan B (2009) Surgical site infections following open reduction and internal fixation of ankle fractures. Open Orthop J 22:56–60CrossRef
6.
go back to reference Watanabe M, Sakai D, Matsuyama D et al (2010) Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation. J Neurosurg Spine 12:540–546PubMedCrossRef Watanabe M, Sakai D, Matsuyama D et al (2010) Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation. J Neurosurg Spine 12:540–546PubMedCrossRef
7.
go back to reference Møller AM, Villebro N, Pedersen T et al (2002) Effect of preoperative smoking intervention on postoperative complications: a randomized clinical trial. Lancet 359:114–117PubMedCrossRef Møller AM, Villebro N, Pedersen T et al (2002) Effect of preoperative smoking intervention on postoperative complications: a randomized clinical trial. Lancet 359:114–117PubMedCrossRef
8.
go back to reference Sørensen LT (2012) Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg 147:373–383PubMedCrossRef Sørensen LT (2012) Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg 147:373–383PubMedCrossRef
9.
go back to reference Fang A, Hu SS, Endres N et al (2005) Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 30:1460–1465CrossRef Fang A, Hu SS, Endres N et al (2005) Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 30:1460–1465CrossRef
10.
go back to reference Veeravagu A, Patil CG, Lad SP et al (2009) Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine (Phila Pa 1976) 34:1869–1872CrossRef Veeravagu A, Patil CG, Lad SP et al (2009) Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine (Phila Pa 1976) 34:1869–1872CrossRef
11.
go back to reference Castillo RC, Bosse MJ, MacKenzie EJ et al (2005) Impact of smoking on fracture healing and risk of complications in limb threatening open tibia fractures. J Orthop Trauma 19:151–157PubMedCrossRef Castillo RC, Bosse MJ, MacKenzie EJ et al (2005) Impact of smoking on fracture healing and risk of complications in limb threatening open tibia fractures. J Orthop Trauma 19:151–157PubMedCrossRef
12.
go back to reference Hawn MT, Houston TK, Campagna EJ et al (2011) The attributable risk of smoking on surgical complications. Ann Surg 254:914–920PubMedCrossRef Hawn MT, Houston TK, Campagna EJ et al (2011) The attributable risk of smoking on surgical complications. Ann Surg 254:914–920PubMedCrossRef
13.
go back to reference Berthelot P, Grattard F, Cazorla C et al (2010) Is nasal carriage of Staphylococcus aureus the main acquisition pathway for surgical-site infection in orthopaedic surgery? Eur J Clin Microbiol Infect Dis 29:373–382PubMedCrossRef Berthelot P, Grattard F, Cazorla C et al (2010) Is nasal carriage of Staphylococcus aureus the main acquisition pathway for surgical-site infection in orthopaedic surgery? Eur J Clin Microbiol Infect Dis 29:373–382PubMedCrossRef
14.
go back to reference National Institute for Health and Clinical Excellence (NICE) (2008) Prevention and treatment of surgical site infection. Clinical guidelines. RCOG Press, London National Institute for Health and Clinical Excellence (NICE) (2008) Prevention and treatment of surgical site infection. Clinical guidelines. RCOG Press, London
15.
go back to reference Malik MHA, Gray J, Kay PR (2004) Early aseptic loosening of cemented total hip arthroplasty: the influence of non-steroidal anti-inflammatory drugs and smoking. Int Orthop 28:211–213PubMedCrossRef Malik MHA, Gray J, Kay PR (2004) Early aseptic loosening of cemented total hip arthroplasty: the influence of non-steroidal anti-inflammatory drugs and smoking. Int Orthop 28:211–213PubMedCrossRef
16.
go back to reference Dinah AF, Vickers RH (2007) Smoking increases failure rate of operation for established non-union of the scaphoid bone. Int Orthop 31:503–505PubMedCrossRef Dinah AF, Vickers RH (2007) Smoking increases failure rate of operation for established non-union of the scaphoid bone. Int Orthop 31:503–505PubMedCrossRef
17.
go back to reference Azodi OS, Bellocco R, Eriksson K et al (2006) The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone Joint Surg Br 88B:1316–1320 Azodi OS, Bellocco R, Eriksson K et al (2006) The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone Joint Surg Br 88B:1316–1320
18.
go back to reference Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Contr Hosp Epidemiol 13:606–608CrossRef Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Contr Hosp Epidemiol 13:606–608CrossRef
19.
go back to reference Chen Y, Guo Q, Pan X et al (2011) Smoking and impaired bone healing: will activation of cholinergic anti-inflammatory pathway be the bridge? Int Orthop 35:1267–1270PubMedCrossRef Chen Y, Guo Q, Pan X et al (2011) Smoking and impaired bone healing: will activation of cholinergic anti-inflammatory pathway be the bridge? Int Orthop 35:1267–1270PubMedCrossRef
20.
go back to reference Rahman MM, Laher I (2007) Structural and functional alteration of blood vessels caused by cigarette smoking: an overview of molecular mechanisms. Curr Vasc Pharmacol 5:276–279PubMedCrossRef Rahman MM, Laher I (2007) Structural and functional alteration of blood vessels caused by cigarette smoking: an overview of molecular mechanisms. Curr Vasc Pharmacol 5:276–279PubMedCrossRef
21.
22.
go back to reference Perretti-Watel P, Halfen S, Gremy I (2007) The “moral careers” of cigarettes mokers: a French survey. Health Risk Soc 9:259–273CrossRef Perretti-Watel P, Halfen S, Gremy I (2007) The “moral careers” of cigarettes mokers: a French survey. Health Risk Soc 9:259–273CrossRef
23.
go back to reference Lindström D, Azodi OS, Wladis A et al (2008) Effects of a perioperative smoking cessation intervention on postoperative complications. A randomized trial. Ann Surg 248:739–745PubMedCrossRef Lindström D, Azodi OS, Wladis A et al (2008) Effects of a perioperative smoking cessation intervention on postoperative complications. A randomized trial. Ann Surg 248:739–745PubMedCrossRef
Metadata
Title
Smoking is a risk factor of organ/space surgical site infection in orthopaedic surgery with implant materials
Authors
François Durand
Philippe Berthelot
Celine Cazorla
Frederic Farizon
Frederic Lucht
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 4/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-1814-8

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