Modifiable Risk Factors for Surgical Site Infection
Calin S. Moucha, MD; Terry Clyburn, MD; Richard P. Evans, MD; Laura Prokuski, MD

Multiple risk factors for orthopaedic surgical site infection, including a wide variety of demographic, comorbid, operative, and postoperative variables, have been identified1. The patient as a host is an important risk factor for infection, and many, if not most, patients are in suboptimal health. Optimizing the patient’s medical condition before surgery and eliminating or even diminishing modifiable risk factors for infection (Fig. 1) should lower the risk of surgical site infection. Direct scientific evidence showing that modification of these risk factors will lead to a decrease in surgical site infection is not readily available, and much work in this field remains to be done. It is imperative that surgeons have an extensive knowledge of modifiable risk factors affecting the wound-healing process and subsequent wound complications.

Fig. 1

Modifiable risk factors. Many patients have risk factors that make them more susceptible to the development of infections. A number of those infections may be preventable through the identification and treatment of modifiable risk factors. MRSA = methicillin-resistant Staphylococcus aureus. (Reprinted from: The American Academy of Orthopaedic Surgeons Patient Safety Committee, Evans RP. Surgical site infection prevention and control: an emerging paradigm. J Bone Joint Surg Am. 2009;91 Suppl 6:2-9.)

Modifiable Risk Factors for Surgical Site Infection and Possible Preoperative Interventions

Rheumatoid Arthritis

Patients with rheumatoid arthritis have an increased risk of infection following orthopaedic procedures. Patients with rheumatoid arthritis who undergo total joint arthroplasty have a two to three times greater risk of acquiring a postoperative surgical site infection than do patients with osteoarthritis2-4. Patients with rheumatoid arthritis are frequently being treated with complex drug regimens that include nonsteroidal anti-inflammatory drugs, corticosteroids, methotrexate, and biologics, all of which have an effect on wound-healing and the risk of infection. There are insufficient data from patients who have undergone orthopaedic procedures to make evidence-based recommendations about the majority of these medications. A …

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