Postoperative wound infections in orthopaedic surgery

ABSTRACT

To compare the effect of theatre condition on postoperative infection rate. Design of study An observational and comparative study Place and Duration of Study Jinnah Postgraduate Medical Centre and Mehran Clinic [Pvt] Karachi from January, 1999 till January, 2000. Subjects and Two hundred and fifty-two patients, 108 at a public hospital and 144 at a private hospital were included in the study. Only clean cases undergoing surgery were included. All were given pre and postoperative antibiotics for seventy hours intravenously. All wounds were closed with monofilament sutures. Follow-up period was twenty eight days. All cases were evaluated for postoperative fever, marginal necrosis and discharge from wound. Cultures were taken from all the cases with any of the above findings. The mean age of the patients was 30.39+21.49 years with male to female ratio of 1.7 to 1. The mean operating time was 53.4 ' 26.81 minutes, however, it was 72+34.2 minutes in cases developing wound infection. The difference was significant when compared to non infected cases. The overall rate of postoperative wound infection was 3.97%. The rate of postoperative wound infection in the public hospital was 5.55% in comparison to 2.75% in the private hospital, which is, though much higher, is statistically not significant. The higher rate may be due to the difference in the theatre environment. Eighty% of the cultured organisms were multidrug resistant strains as compared to 20% sensitive to the first generation cephalosporins. The difference was highly significant. There was no significant difference in the postoperative wound infection rate between the two groups, however, there was an association with operating time. Significantly most of infections were caused by hospital- born multidrug resistant organisms