Methods: Patient records were queried using Current Procedural Terminology codes from a single Veterans Affairs Medical Center that underwent clean, elective CTR from 10/2014 through 4/2017 were reviewed. Demographic and clinical data were obtained through chart extraction. Multivariate logistic regression was used to assess the association between infection and patient demographic characteristics, clinical characteristics, and operating environment. The National Healthcare Safety Network definition for SSI was used.
Results: A total of 312 procedures were included in the analysis; 221 procedures in the OR and 91 in the PR. Mean age was 63yrs; 88% male. 64 (21%) smoked, 80 (26%) were diabetic. Mean BMI was 32.9 kg/m2. The overall infection rate was 2.88%. After adjusting for covariates, procedure setting was not associated with risk of SSI (p=0.53; OR=0.43; 95% CI: 0.03-5.94). Same-wrist revision CTR was a significant predictor of SSI (p=0.02; OR=28.21; CI: 1.84-434.57). CTR performed in the OR had a similar risk for SSI compared to CTR performed in the PR. The mean total cost of CTR in the OR was $4,254 as compared to the PR total cost of $417.
Conclusion: The rate of SSI following primary and revision CTR in a high morbidity US Veteran population was 2.88%, much higher than in non-veteran populations with lower morbidity. Other studies have found that pre-procedural optimization of modifiable risk factors such as blood glucose control, smoking status and weight is important. There was no difference in rate of SSI between the OR and PR environments. Revision CTR appears to be higher risk for SSI. A larger sample size is important to validate these findings. Minimally invasive procedures performed in a PR could lead to greater patient satisfaction, access to surgery, higher efficiency, and a 10-fold cost-savings.
A. Gravely, None
A. S. DeVries, None