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Surgeon volume and the risk of deep surgical site infection following open reduction and internal fixation of closed tibial plateau fracture

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Abstract

Background

Emerging evidences supported that the surgeon case volume significantly affected post-operative complications or outcomes following a range of elective or non-elective orthopaedic surgery; no data has been available for surgically treated tibial plateau fractures. We aimed to investigate the relationship between surgeon volume and the risk of deep surgical site infection (DSSI) following open reduction and internal fixation (ORIF) of closed tibial plateau fracture.

Methods

This was a further analysis of the prospectively collected data. Adult patients undergoing ORIF procedure for closed tibial plateau fracture between January 2016 and December 2019 were included. Surgeon volume was defined as the number of surgically treated tibial fractures in the preceding 12 months and dichotomized on the basis of the optimal cut-off value determined by the receiver operating characteristic (ROC) curve. The outcome was DSSI within one year post-operatively. Multiple multivariate logistic models were constructed for “drilling down” adjustment of confounders. Sensitivity and subgroup analyses were performed to assess the robustness of outcome and identify the “optimal” subgroups.

Results

Among 742 patients, 20 (2.7%) had a DSSI and 17 experienced re-operations. The optimal cut-off value for case volume was nine, and the low-volume surgeon was independently associated with 2.9-fold (OR, 2.9; 95%CI, 1.1 to 7.5) increased risk of DSSI in the totally adjusted multivariate model. The sensitivity analyses restricted to patients with original BMI data or those operated within 14 days after injury did not alter the outcomes (OR, 2.937, and 95%CI, 1.133 to 7.615; OR, 2.658, and 95%CI, 1.018 to 7.959, respectively). The subgroup analyses showed a trend to higher risk of DSSI for type I–IV fractures (OR, 4.6; 95%CI, 0.9 to 27.8) classified as Schatzker classification and substantially higher risk in patients with concurrent fractures (OR, 6.1; 95%CI, 1.0 to 36.5).

Conclusion

The surgeon volume is independently associated with the rate of DSSI, and a number of ≥ nine cases/year are necessarily kept for reducing DSSIs; patients with concurrent fractures should be preferentially operated on by high-volume surgeons.

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Data availability

All the data will be available upon motivated request to the corresponding author of the present paper.

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Acknowledgements

We are grateful to K. Z. and X. L. of the Department of Orthopaedics and to Q. W and X. Z. of the Department of Statistics and Applications for their kind assistance.

Funding

This study was supported by a 3–3-3 talent project for high-level talents of Hebei Province (No. A2017005073).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, the 3Rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Yanbin Zhu, Shiji Qin, Junyong Li, Wei Chen, Qi Zhang & Yingze Zhang

  2. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Yanbin Zhu, Shiji Qin, Junyong Li, Wei Chen, Qi Zhang & Yingze Zhang

  3. Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Yanbin Zhu, Shiji Qin, Junyong Li, Wei Chen, Qi Zhang & Yingze Zhang

  4. NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Yanbin Zhu, Shiji Qin, Junyong Li, Wei Chen, Qi Zhang & Yingze Zhang

  5. Basic Medicine School of Hebei Medical University, Shijiazhuang, 050000, Hebei, People’s Republic of China

    Yuxuan Jia

  6. Chinese Academy of Engineering, Beijing, 100088, People’s Republic of China

    Yingze Zhang

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  1. Yanbin Zhu
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Contributions

Y. Z. and Q. Z. conceived the idea and designed the study. J. L, W. C. and Y. Zhu retrieved the data. S. Q. prepared the figures and tables. Y. Z. performed the statistical analyses. All the authors interpreted the data and contributed to preparation of the manuscript. Y. Zhu and S. Q. wrote the manuscript and contributed equally. Yuxuan Jia contributed to the revision of the manuscript.

Corresponding authors

Correspondence to Qi Zhang or Yingze Zhang.

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Ethics approval

The study protocol was approved by the ethics committee of the Third Hospital of Hebei Medical University (No. 2014–015-1).

Consent to participate

Informed consent to participate in the SSIOS database and this study were obtained for every included patient, before the database was initiated.

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Informed consent to publish the relevant data was obtained for every included patient, before the database was initiated.

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The authors declare no competing interests.

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Level of evidence: Prognostic, Level II

Yanbin Zhu and Shiji Qin are contributed equally to this work

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Zhu, Y., Qin, S., Jia, Y. et al. Surgeon volume and the risk of deep surgical site infection following open reduction and internal fixation of closed tibial plateau fracture. International Orthopaedics (SICOT) 46, 605–614 (2022). https://doi.org/10.1007/s00264-021-05221-z

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