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. 2015 Jul;3(3):184-92.

Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and Predictors

Mohammad R Rasouli  1 , Jessica Viola  1 , Mitchell G Maltenfort  1 , Alisina Shahi  1 , Javad Parvizi  1 , James C Krieg  1
Affiliations

Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and Predictors

Mohammad R Rasouli et al. Arch Bone Jt Surg. 2015 Jul.

Abstract

Background: Little is known about trends and predictors of hardware related infection following open reduction and internal fixation (ORIF) of extremity fractures, one of the major causes of failure following ORIF. The present study was designed and conducted to determine trends and predictors of infection-related hardware removal following ORIF of extremities using a nationally representative database.

Methods: We used Nationwide Inpatient Sample data from 2002 to 2011 to identify cases of ORIF following upper and lower extremity fractures, as well as cases that underwent infection-related hardware removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related hardware removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year.

Results: For all ORIF procedures, the highest rate of hardware removal related to infection was observed in tarsal fractures (5.56%), followed by tibial (3.65%) and carpal (3.37%) fractures. Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Tarsal fractures(odds ratio (OR)=1.06, 95% confidence interval (CI): 1.04-1.09, P<0.001), tibial fractures (OR=1.04, 95% CI: 1.03-1.06, P<0.001) and those patients with diabetes mellitus (OR=2.64, 95% CI: 2.46-2.84, P<0.001), liver disease (OR=2.04, 95% CI: 1.84- 2.26, P<0.001), and rheumatoid arthritis (OR=2.06, 95% CI: 1.88-2.25 P<0.001) were the main predictors of infection-related removals; females were less likely to undergo removal due to infection (OR= 0.61, 95% CI: 0.59-0.63 P<0.001).

Conclusions: Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related hardware removal. The study identified some risk factors for hardwarerelated infection following ORIF, such as diabetes, liver disease, and rheumatoid arthritis, that should be studied further in an attempt to implement strategies to reduce rate of infection following ORIF.

Keywords: Hardware Removal; Infection; NIS; ORIF.

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Figures

Figure 1
Figure 1
Average rates of hardware removals out of all open reduction and internal fixation (ORIF) procedures (outer layer), infected hardware out of all ORIF procedures (middle layer), and infected hardware within the removal group (inner layer).
Figure 2
Figure 2
Trends of open reduction and internal fixation (ORIF), hardware removals, and infection-related hardware removals in upper and lower extremity fractures during 2002-2011 per 100000 national population.
Figure 3
Figure 3
Rate of hardware removal and hardware removal related to infection in different type of fractures.
Figure 4
Figure 4
Length of stay for hardware removals in various fracture regions. Left and right panels respectively depict length of stay for infected and non-infected hardware removals based on the site of the fracture.
Figure 5
Figure 5
Comparison of hospital charges between infectedand non-infected cases of hardware removal in upper and lower extremity fractures. Left and right panels respectively depict hospital charges for non-infected and infected hardware removals based on the site of the fracture.
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