Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery?
Abstract. Objectives:. The purpose of this investigation was to evaluate the utility of the Centers for Disease Control (CDC) Surgical Wound Classification (SWC) in predicting surgical site infection (SSI) after orthopaedic trauma procedures. Design:. Retrospective cohort study. Setting:. Level I ac...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-03-01
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| Series: | OTA International |
| Online Access: | http://journals.lww.com/10.1097/OI9.0000000000000357 |
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| author | Elizabeth Cho, MD Hanna House, MD Andrew Marten, BS Marina Feffer, MPH Julie Agel, MA John Scolaro, MD Meir Marmor, MD Ashley E. Levack, MD, MAS OTA Classification & Outcomes Committee James Kellam, MD Gillian Soles, MD Jarrod Dumpe, MD Kyle Schweser, MD Geoffrey Maracek, MD |
| author_facet | Elizabeth Cho, MD Hanna House, MD Andrew Marten, BS Marina Feffer, MPH Julie Agel, MA John Scolaro, MD Meir Marmor, MD Ashley E. Levack, MD, MAS OTA Classification & Outcomes Committee James Kellam, MD Gillian Soles, MD Jarrod Dumpe, MD Kyle Schweser, MD Geoffrey Maracek, MD |
| author_sort | Elizabeth Cho, MD |
| collection | DOAJ |
| description | Abstract. Objectives:. The purpose of this investigation was to evaluate the utility of the Centers for Disease Control (CDC) Surgical Wound Classification (SWC) in predicting surgical site infection (SSI) after orthopaedic trauma procedures.
Design:. Retrospective cohort study.
Setting:. Level I academic trauma center.
Patients/Participants:. Adult patients with operatively treated fractures of the leg, ankle, and hindfoot between 2007 and 2022.
Intervention:. N/A.
Main Outcome Measurements:. Presence of SSI was determined by selective chart review of patients who met the screening variables for repeated procedures, open fracture, abscess or wound debridement, intraoperative cultures, or infectious disease consultation (n = 551).
Results:. Two thousand seven hundred ninety-one fractures among 2780 patients (n = 11 with bilateral fractures) were included. The overall infection rate was 2.3% (n = 63), and SWC was significantly associated with infection rates (I/clean: 1.0%, II/clean-contaminated: 3.4%, III/contaminated: 6.2%, IV/dirty: 9.8%, P < 0.001). When compared with Class I, Classes II through IV had increased odds of infection (odds ratio [OR] II: 3.5, P = 0.012; OR III: 6.8, P < 0.001; OR IV: 11.0, P < 0.001). Subgroup analysis of Classes II and III demonstrated no difference in odds of infection. When stratifying open versus closed fractures, there was no statistical association between CDC SWC and odds of infection.
Conclusions:. The CDC SWC has notable limitations for patients with orthopaedic trauma, with ambiguity of classification assignment and decreased discriminatory ability within the central classes. While overall SWC is associated with infection, the relationship seems to be confounded by the effect of open versus closed fractures. Alternative classification systems may have improved utility for stratifying risk in orthopaedic patients.
Level of Evidence:. III. |
| format | Article |
| id | doaj-art-13ef1981641a4e00af8446643abf3f8d |
| institution | Kabale University |
| issn | 2574-2167 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | OTA International |
| spelling | doaj-art-13ef1981641a4e00af8446643abf3f8d2025-01-24T09:20:32ZengWolters KluwerOTA International2574-21672025-03-018110.1097/OI9.0000000000000357OI90000000000000357Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery?Elizabeth Cho, MD0Hanna House, MD1Andrew Marten, BS2Marina Feffer, MPH3Julie Agel, MA4John Scolaro, MD5Meir Marmor, MD6Ashley E. Levack, MD, MAS7OTA Classification & Outcomes CommitteeJames Kellam, MDGillian Soles, MDJarrod Dumpe, MDKyle Schweser, MDGeoffrey Maracek, MDa Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, ILa Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, ILb Stritch School of Medicine, Loyola University Chicago, Maywood, ILb Stritch School of Medicine, Loyola University Chicago, Maywood, ILc Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WAd Department of Orthopaedic Surgery, University of California Irvine, Irvine, CAe Zuckerberg San Francisco General Hospital, Orthopaedic Trauma Institute, University of California San Francisco, San Francisco, CA.a Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, ILAbstract. Objectives:. The purpose of this investigation was to evaluate the utility of the Centers for Disease Control (CDC) Surgical Wound Classification (SWC) in predicting surgical site infection (SSI) after orthopaedic trauma procedures. Design:. Retrospective cohort study. Setting:. Level I academic trauma center. Patients/Participants:. Adult patients with operatively treated fractures of the leg, ankle, and hindfoot between 2007 and 2022. Intervention:. N/A. Main Outcome Measurements:. Presence of SSI was determined by selective chart review of patients who met the screening variables for repeated procedures, open fracture, abscess or wound debridement, intraoperative cultures, or infectious disease consultation (n = 551). Results:. Two thousand seven hundred ninety-one fractures among 2780 patients (n = 11 with bilateral fractures) were included. The overall infection rate was 2.3% (n = 63), and SWC was significantly associated with infection rates (I/clean: 1.0%, II/clean-contaminated: 3.4%, III/contaminated: 6.2%, IV/dirty: 9.8%, P < 0.001). When compared with Class I, Classes II through IV had increased odds of infection (odds ratio [OR] II: 3.5, P = 0.012; OR III: 6.8, P < 0.001; OR IV: 11.0, P < 0.001). Subgroup analysis of Classes II and III demonstrated no difference in odds of infection. When stratifying open versus closed fractures, there was no statistical association between CDC SWC and odds of infection. Conclusions:. The CDC SWC has notable limitations for patients with orthopaedic trauma, with ambiguity of classification assignment and decreased discriminatory ability within the central classes. While overall SWC is associated with infection, the relationship seems to be confounded by the effect of open versus closed fractures. Alternative classification systems may have improved utility for stratifying risk in orthopaedic patients. Level of Evidence:. III.http://journals.lww.com/10.1097/OI9.0000000000000357 |
| spellingShingle | Elizabeth Cho, MD Hanna House, MD Andrew Marten, BS Marina Feffer, MPH Julie Agel, MA John Scolaro, MD Meir Marmor, MD Ashley E. Levack, MD, MAS OTA Classification & Outcomes Committee James Kellam, MD Gillian Soles, MD Jarrod Dumpe, MD Kyle Schweser, MD Geoffrey Maracek, MD Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery? OTA International |
| title | Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery? |
| title_full | Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery? |
| title_fullStr | Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery? |
| title_full_unstemmed | Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery? |
| title_short | Does the CDC Surgical Wound Classification adequately predict postoperative infection in lower extremity fracture surgery? |
| title_sort | does the cdc surgical wound classification adequately predict postoperative infection in lower extremity fracture surgery |
| url | http://journals.lww.com/10.1097/OI9.0000000000000357 |
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