Postoperative Infection Following Open Reduction and Internal Fixation of Fractures: Risk Factors and Outcomes

Open Access

Abstract

Background: Postoperative surgical site infections after ORIF of fractures cause high patient morbidity, prolonged hospital stays, and complications related to implants and recovery. The study aimed to identify the prevalence, trend, and risk factors of postoperative infections after ORIF of fractures in a tertiary care centre in Bangladesh.  Methods & Materials: This prospective observational study was carried out at the 250 Bedded District Hospital- Kurigram, Bangladesh, between February 2024 and January 2025. Patients with closed or open fractures treated with ORIF were recruited. Cases that had active infection before, had undergone antibiotic treatment within 48 hours or had a follow-up of less than 6 weeks were excluded. Postoperative SSIs were defined per CDC criteria. Data were entered and analysed using SPSS version 26. Findings: The mean age of the participants was 39.8±12.1 years, and a male majority (70%). Infection after surgery was experienced by 23.3% patients, with 64.3% and 35.7% having superficial and deep SSIs, respectively. The most common isolate was Staphylococcus aureus (42.9%). The major risk factors were diabetes mellitus (p=0.019), open fracture (p=0.018), and operation time longer than 120 minutes (p=0.041). Infected patients had significantly longer hospital stays (14.8 ± 5.2 vs. 8.1 ± 2.9 days; p<0.001), higher rates of delayed wound healing (71.4% vs. 13.0%; p<0.001), and poorer functional outcomes (50% vs. 13%; p=0.006).  Conclusion: Postoperative infection after ORIF has serious outcomes. Modifiable risk factors include diabetes mellitus, open fractures, and prolonged operative time. Appropriate perioperative measures are needed to reduce surgical site infections and improve surgical outcomes.