Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction

Michael V. Murphy, Dongyi Du, Wei Hua, Karoll J. Cortez, Melissa G. Butler, Robert Davis, Thomas A. Decoster, Laura Johnson, Lingling Li, Cynthia Nakasato, James D. Nordin, Mayur Ramesh, Michael Schum, Ann Von Worley, Craig Zinderman, Richard Platt, Michael Klompas

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008. METHODS We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients' demographic characteristics, comorbidities, and choice of graft. RESULTS On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%-1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%-3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8-12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3-4.8). CONCLUSIONS The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients. Infect Control Hosp Epidemiol 2016;37:827-833.

Original languageEnglish (US)
Pages (from-to)827-833
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume37
Issue number7
DOIs
StatePublished - Feb 12 2016

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Surgical Wound Infection
Anterior Cruciate Ligament Reconstruction
Autografts
Allografts
Bone and Bones
Patellar Ligament
Infection
Transplants
Wound Infection
Medical Records
Odds Ratio
Comorbidity
Cohort Studies
Retrospective Studies
Logistic Models
Demography
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction. / Murphy, Michael V.; Du, Dongyi; Hua, Wei; Cortez, Karoll J.; Butler, Melissa G.; Davis, Robert; Decoster, Thomas A.; Johnson, Laura; Li, Lingling; Nakasato, Cynthia; Nordin, James D.; Ramesh, Mayur; Schum, Michael; Von Worley, Ann; Zinderman, Craig; Platt, Richard; Klompas, Michael.

In: Infection Control and Hospital Epidemiology, Vol. 37, No. 7, 12.02.2016, p. 827-833.

Research output: Contribution to journalArticle

Murphy, MV, Du, D, Hua, W, Cortez, KJ, Butler, MG, Davis, R, Decoster, TA, Johnson, L, Li, L, Nakasato, C, Nordin, JD, Ramesh, M, Schum, M, Von Worley, A, Zinderman, C, Platt, R & Klompas, M 2016, 'Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction', Infection Control and Hospital Epidemiology, vol. 37, no. 7, pp. 827-833. https://doi.org/10.1017/ice.2016.65
Murphy, Michael V. ; Du, Dongyi ; Hua, Wei ; Cortez, Karoll J. ; Butler, Melissa G. ; Davis, Robert ; Decoster, Thomas A. ; Johnson, Laura ; Li, Lingling ; Nakasato, Cynthia ; Nordin, James D. ; Ramesh, Mayur ; Schum, Michael ; Von Worley, Ann ; Zinderman, Craig ; Platt, Richard ; Klompas, Michael. / Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction. In: Infection Control and Hospital Epidemiology. 2016 ; Vol. 37, No. 7. pp. 827-833.
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AU - Murphy, Michael V.

AU - Du, Dongyi

AU - Hua, Wei

AU - Cortez, Karoll J.

AU - Butler, Melissa G.

AU - Davis, Robert

AU - Decoster, Thomas A.

AU - Johnson, Laura

AU - Li, Lingling

AU - Nakasato, Cynthia

AU - Nordin, James D.

AU - Ramesh, Mayur

AU - Schum, Michael

AU - Von Worley, Ann

AU - Zinderman, Craig

AU - Platt, Richard

AU - Klompas, Michael

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N2 - OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008. METHODS We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients' demographic characteristics, comorbidities, and choice of graft. RESULTS On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%-1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%-3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8-12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3-4.8). CONCLUSIONS The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients. Infect Control Hosp Epidemiol 2016;37:827-833.

AB - OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008. METHODS We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients' demographic characteristics, comorbidities, and choice of graft. RESULTS On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%-1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%-3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8-12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3-4.8). CONCLUSIONS The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients. Infect Control Hosp Epidemiol 2016;37:827-833.

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