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Prevalence and risk factors for postoperative infection in pediatric orthopedic surgery: a study of 458 children - 06/05/08

Doi : RC0E-04-2005-91-2-0035-1040-101019-200517723 

O. Kaabachi [1],

I. Letaief [1],

M.N. Nessib [1],

C. Jelel [1],

A. Ben Abdelaziz [1],

M. Ben Ghachem [1]

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Abstract

Purpose of the study

The incidence of postoperative infection in pediatric surgery has been studied little in the literature. It would be lower than in adults. In the present work, we attempted to define the incidence of postoperative infection in orthopedic pediatric surgery and identify risk factors.

Material and methods

This was a retrospective analysis of 458 children who underwent surgery between 1998 and 1999 for the following conditions: talipes equinus, congenital hip dislocation, supracondylar fracture of the elbow, and femur shaft fracture. We noted the prevalence of infection of the surgical site, the type of infection and its course as well as the principal risk factors incriminated: age, condition, surgical modalities (emergency setting, hour, bleeding) and use of antibiotic prophylaxis.

Results

Mean age at surgery was 5.4 ± 3.5 years. The sex ratio was 1.6 boys/1 girl. Forty-two patients developed an infection of the surgical site, giving an incidence of 9.2% of the patients and 8.3% of the surgical sites. Postoperative infection was more frequent in the talipes equinus group (19.4% versus 5.8% for supracondylar fractures of the elbow, 2% for femur shaft fractures, and 0% for congenital hip displacement). In 78.6% of the cases, the infection was superficial. The analysis of risk factors showed that talipes equinus is an independent risk factor. The absence of antibiotic prophylaxis increased the risk of infection of the surgical site significantly only in the talipes equinus group (40.7% versus 14%).

Discussion

The incidence of infection of the surgical site in pediatric orthopedic surgery was high in our series, 8.3% versus 0.4% and 5.6% reported in the literature. Talipes equinus surgery exposes the child to a significant risk of infection. The principal risk factors related to surgery would be: ischemia, inflammation of cutaneous and subcutaneous tissue due to detachment, the tourniquet, and the absence of antibiotic prophylaxis.

Keywords: Postoperative infection , pediatric surgery , orthopedic surgery , child , prophylactic antibiotics


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© 2005 Elsevier Masson SAS. Tous droits réservés.
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Vol 91 - N° 2

P. 103-108 - avril 2005 Regresar al número

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