Atopic dermatitis is a novel demographic risk factor for surgical site infection after anterior cruciate ligament reconstruction
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Although various risk factors for surgical site infection after anterior cruciate ligament reconstruction (ACLR) have been reported, the number of studies with large sample sizes on this topic is limited. The aim of the present study was to clarify the risk factors for early surgical site infection after ACLR in a large cohort using a national database in Japan.
The data of patients who underwent ACLR from 2010 to 2015 were obtained from the Diagnosis Procedure Combination database, which covers approximately half of all hospital admissions in Japan. The outcome measures were the prevalences of surgical site infection and deep surgical site infection after ACLR during hospitalization. The association between the occurrence of surgical site infection and patients’ demographic data, including sex, age, body mass index (BMI), smoking status, preoperative steroid use, and comorbidities such as diabetes, hepatic dysfunction, renal dysfunction, and atopic dermatitis, were examined using a multivariable logistic regression model.
Among 30,536 patients who underwent ACLR, 288 patients with surgical site infection (0.94%) and 86 with deep surgical site infection (0.28%) were identified. The univariate analysis showed that higher prevalences of surgical site infection and deep surgical site infection were associated with male sex, a higher BMI, atopic dermatitis, and preoperative steroid use. Patients with diabetes or hepatic dysfunction had a significantly higher prevalence of surgical site infection. The multivariable analysis showed that surgical site infection was significantly associated with male sex vs. female sex; odds ratio (OR), 2.90; 95% confidence interval (CI), 2.17–3.89, age of ≤ 19 vs. 20–29 years; OR, 1.56; 95% CI 1.13–2.15, BMI of ≥ 30.0 vs. 18.5–22.9 kg/m2; OR, 1.72; 95% CI 1.16–2.54, diabetes (OR, 2.70; 95% CI 1.28–5.71), atopic dermatitis (OR, 7.19; 95% CI 2.94–17.57), and preoperative steroid use (OR, 6.18; 95% CI 2.32–16.52).
Atopic dermatitis, preoperative steroid use, young age (≤ 19 years), obesity (BMI of ≥ 30.0 kg/m2), male sex, and diabetes were independent demographic risk factors for surgical site infection after ACLR. The present study will be useful when surgeons evaluate the risk of SSI after ACLR in terms of demographic aspects.
Level of evidence
KeywordsAnterior cruciate ligament reconstruction Surgical site infection Atopic dermatitis
KF and HY collected the data. MK, YS, ShT, HI, HY and SaT designed the study. MK, YS, ShT, HI, HM, and HY analysed and interpreted the data. MK, YS, ShT, HI, and HY drafted the manuscript. All authors had complete access to all data (including statistical reports and tables) used in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.
This work was supported by Grants from the Ministry of Health, Labour and Welfare, Japan (H29-Policy-Designated-009 and H29-ICT-General-004); Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141); and the Japan Agency for Medical Research and Development (AMED). The sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval and Informed consent
The Ethics Committee of the University of Tokyo approved the study design and waived the requirement for informed consent because all data are anonymous (approval number: 3501).
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