Abstract
Objectives Surgical-site infections (SSIs) can complicate virtually any surgical procedure.
While SSI can result from numerous causes, contamination of the surgical field can
also contribute to it. Intraoperative bacterial contamination during clean orthopaedic
procedures can be detected using perioperative cultures. We hypothesized that perioperative
cultures could be used to predict possibility of development of SSI in patients undergoing
clean orthopaedic surgeries.
Materials and Methods We conducted a prospective cohort study at a tertiary care hospital over a 2-year
period. Intraoperative surgical wound lavage fluid and closed suction drain tip obtained
in the postoperative period were sent for aerobic culture. All patients were followed
up to look for the development of SSI for a period of at least 30 days for those undergoing
nonimplant surgery, and 90 days for those with implant surgery.
Statistical Analysis Means with standard deviation of the continuous data were calculated. Fisher's exact
test and chi-square test were used for the analysis of the categorical variables.
Relative risk and odds ratio were calculated to evaluate the association of the parameters
under study with SSI.
Results A total of 384 patients satisfying the inclusion and exclusion criteria were included.
Perioperative cultures detected surgical wound contamination in 39 patients (10.1%).
Forty-five patients (11.7%) developed SSI during the follow-up period. Skin commensals
constituted 59% of perioperative contaminants and accounted for 20% of the SSIs. The
relative risk of developing SSI with perioperative contamination was 0.41 (95% confidence
interval: 0.09–1.63).
Conclusion Intraoperative surgical-site contaminants could be detected using perioperative cultures.
However, these contaminants did not lead to SSI. Timely treatment of perioperative
contamination with appropriate antibiotics and local wound care probably helped in
the reduction of SSI.
Keywords
Clean orthopaedic surgery - intraoperative contamination - surgical-site infection
- perioperative - aerobic culture - SSI rate
