Risk factors for surgical site infection following operative treatment of ankle fractures: A systematic review and meta-analysis

Background: This study aims to quantitatively summarize risk factors associated with surgical site infection after open reduction and internal fixation of ankle fractures. Methods: Relevant original studies were searched in Medline, Embase, China National Knowledge Infrastructure, Wanfang database and Cochrane central database (all through April 2018). Studies eligible had to meet the quality assessment criteria by Newcastle-Ottawa Scale and to evaluate the risk factors for surgical site infection after open reduction and internal fixation of ankle fractures. The Stata 11.0 was used to this meta-analysis. Results: 10 studies involving 8103 cases of ankle fracture treated by open reduction and internal fixation and 583 cases of surgical site infection were included in this meta-analysis. The incidence of surgical site infection is 7.19%. Our meta-analysis identified the significant increased risk factors with surgical site infection after open reduction and internal fixation of ankle fractures (P < 0.05) is: body mass index (both continuous and dichotomous variables); American Society of Anesthesiologists >= 3; diabetes; alcohol; open fracture; subluxation/dislocation; incision cleanness grade 2-4; high-energy mechanism; chronic heart disease; history of allergy; and use of antibiotic prophylaxis. After sensitivity analysis, meta-analysis results for these factors did not change the significance, indicating that the results were robust. Conclusion: Patients involved with the above-mentioned medical conditions were at risk for surgical site infection after open reduction and internal fixation of ankle fracture. The present study may in this respect serve as a baseline reference and this knowledge will allow the formulation of public health strategies to prevent surgical site infection after orthopedic surgery.