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.
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Acknowledgments
The authors thank the Study Group Members.
Seventeen French Centers took part in this clinical trial.: the University Hospital of Saint-Etienne (MH.Fessy1, F.Farizon1, AC.Vautrin2); the “Clinique Mutualiste” of Saint-Etienne (JP.Passot1, JP.Fayard1, F.Chalencon1, JM.Semay1, L.Dupre La Tour1, L.Beguin1, R.Meley2); the “Centre Hospitalier Privé de la Loire of Saint-Etienne” (A.Mesguich1, DG.Avet1, PH.Charlier1, M.Rousson2); the “Clinique du Parc” of Saint-Etienne (L.Charmion1, E.Puech2); the Military Hospital Desgenettes of Lyon (JP.Romanet1, F.Rongiéras1, P.Lainé1, F.Chauvin1, M.Branfaux1, B.Chevalier2); the University Hospital of Lyon (J.Bejuy1, JP.Carret1, P.Neyret1, F.Lecuire1, J.Rubini1, M.Basso1, I.Benareau1, P.Girardo2, S.Tigaud2, J.Carrere2, C.Galabert2, D. Peyramond3); the “Clinique Sainte-Anne” of Lyon (M.Bonnin1, JP.Hager1, P.Chambat1, A.François2); the University Hospital of Grenoble (P.Merloz1, J.Croize2, JP Stahl3); the “Clinique des Cévennes” of Annonay (A.Mironneau1, E.Forestier2); the Hospital of Montbrison (P.Girardin1, F.Crepet2); the Hospital of Roanne (A.Durand1, W.Tohoubi1, D.Raou1, M.Boyer2); the “Clinique Orthopédique Médico-Chirurgicale” of Dracy-le-Fort (Dr P.Deroche1, G.Deschamps1, S.Rizk1, C.Chol1, P.Ragois1, C.Pomel2); the University Hospital of Nimes (G.Asencio1, R.Bertin1, N.Bouziges2, A.Sotto3 ); the “Clinique Clairval” of Marseille (D.Prost1, JF.Thiery1, M.Chickly1, A.Merabet-Sigwalt2); and the University Hospital of Nice (P.Boileau1, G.Armando1, H.Carsenti2, P.Dellamonica3).
1 = Orthopedic Surgeon; 2 = Microbiologist; 3 = Infectious Diseases Consultant.
The authors also thank Nicolas Eydoux, Estelle Badel, and Fabrice Di Palma for the collection and recording of data.
Contributors
FD, PB, CC, and FL participated in the study design, in the collection, analysis, and interpretation of clinical data, in writing the report, and in the decision to submit the paper for publication. JPP, JPF, JB, MHF, FF participated in various aspects of the trial and patient referral. All authors had full access to all of the data in this study and take complete responsibility for the integrity of data and the accuracy of data analysis.
Conflict of interest statement
The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
Ethical review committee statement
The study protocol was reviewed and approved by the Regional Ethical Research Committee of our University Hospital (CHU Saint Etienne, France).
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Durand, F., Berthelot, P., Cazorla, C. et al. Smoking is a risk factor of organ/space surgical site infection in orthopaedic surgery with implant materials. International Orthopaedics (SICOT) 37, 723–727 (2013). https://doi.org/10.1007/s00264-013-1814-8
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DOI: https://doi.org/10.1007/s00264-013-1814-8