Incidence and Risk Factors of Surgical Site Infection Following Orthopedic Implant Surgeries in a tertiary Healthcare setting at Lahore
DOI:
https://doi.org/10.36283/ziun-pjmd15-1/006Abstract
Background: Surgical site infections (SSIs) are a leading cause of postoperative morbidity following orthopedic implant surgeries, resulting in delayed recovery and high healthcare costs. The aim of this study was to establish the incidence and the risk factors of SSIs after orthopedic implant surgery.
Methods: This descriptive cross-sectional study (April 2024 to July) enrolled 180 patients aged 18 years and above who were undergoing orthopedic implant surgeries. A structured proforma was used to collect data on demographic, clinical and perioperative variables. According to the Centers for Disease Control and Prevention (CDC) guidelines, SSIs were detected. The SPSS version 26.0 was used to perform the statistical analysis using the chi-square and t-tests to make the univariate comparisons and multivariate logistic regression to identify the independent predictors of SSI. A p-value of <0.05 was considered statistically significant.
Results: The total incidence of SSIs was 11.7%(n=21). SSIs were significantly related to diabetes mellitus (p = 0.01), smoking (p = 0.03), and prolonged surgical duration (>2 hour, p = 0.02), as well as antibiotic prophylaxis (p = 0.001) deficit. These were affirmed as independent predictors using multivariate analysis: diabetes (Adjusted Odds Ratio (AOR) = 2.84), smoking (AOR = 2.19), duration more than 2 hours (AOR = 2.61), and no antibiotic prophylaxis (AOR = 4.73).
Conclusion: The incidence of SSI was considerably high in orthopedic implant surgeries. The risk of infection can be reduced significantly by optimizing the use of perioperative antibiotics, controlling diabetes, reducing the length of operation, and deterring smoking.
References
1.Soldevila-Boixader L, Viehöfer A, Wirth S, Waibel F, Yildiz I, Stock M, et al. Risk Factors for Surgical Site Infections in Elective Orthopedic Foot and Ankle Surgery: The Role of Diabetes Mellitus. J Clin Med. 2023 Feb 17;12(4):1608. doi: 10.3390/jcm12041608.
2.Das A, Tripathy SK, Mohapatra I, Poddar N, Pattnaik D, S S, et al. Microbiological Profile and Outcome of Surgical Site Infections Following Orthopedic Surgeries in a Tertiary Care Hospital. Cureus. 2025 Jan 3;17(1):e76874. doi: 10.7759/cureus.76874.
3.Porretto M, Parente F, Del Puente F, Parisini A, Tigano S, Nelli M, et al. Surveillance of surgical site infections in orthopedic prosthetic surgery: a tool for identifying risk factors and improving clinical practice. J Prev Med Hyg. 2024 Aug 31;65(2):E273-E277. doi: 10.15167/2421-4248/jpmh2024.65.2.3141.
4.Zhao H, Meng J, Sun T, Wan Z, Qin S, Zhang F, et al. Risk factors for deep surgical site infection following surgically treated peri-ankle fractures: a case-control study based on propensity score matching. J Orthop Surg Res. 2022 Dec 15;17(1):542. doi: 10.1186/s13018-022-03436-3.
5.Liu H, Wang Y, Xing H, Chang Z, Pan J. Risk factors for deep surgical site infections following orthopedic trauma surgery: a meta-analysis and systematic review. J Orthop Surg Res. 2024 Nov 30;19(1):811. doi: 10.1186/s13018-024-05299-2.
6.Aljuhani WS, Alanazi AM, Saeed AI, Alhadlaq KH, Alhoshan YS, Aljaafri ZA. Patient-related risk factors of prosthetic joint infections following total hip and knee arthroplasty at King Abdulaziz Medical City, a 10-year retrospective study. J Orthop Surg Res. 2023 Sep 22;18(1):717. doi: 10.1186/s13018-023-04210-9.
7.Zuo Q, Li H, Dong B, Zhou Y, Zhao K, Tian P. A Study of Risk Factors for Surgical Site Infections and Direct Economic Losses in Clean Orthopedic Surgery. Surg Infect (Larchmt). 2025 Jun;26(5):336-342. doi: 10.1089/sur.2024.257.
8.Niebuhr D, Mattson T, Jensen NM, Viberg B, Steenstrup Jensen S. Risk factors for tibial infections following osteosynthesis - a systematic review and meta-analysis. J Clin Orthop Trauma. 2024 Feb 23;50:102376. doi: 10.1016/j.jcot.2024.102376.
9.Dreyfus JG, Yu H, Begier E, Gayle J, Olsen MA. Incidence and burden of Staphylococcus aureus infection after orthopedic surgeries. Infect Control Hosp Epidemiol. 2022 Jan;43(1):64-71. doi: 10.1017/ice.2021.65.
10.Motififard M, Teimouri M, Shirani K, Hatami S, Yadegari M. Prevalence of Bacterial surgical site infection in traumatic patients undergoing orthopedic surgeries: a cross-sectional study. Int J Burns Trauma. 2021 Jun 15;11(3):191-196.
11.Bhardwaj R, Agrawal U, Vashist P, Manna S. Determination of sample size for various study designs in medical research: A practical primer. J Family Med Prim Care. 2024 Jul;13(7):2555-2561. doi: 10.4103/jfmpc.jfmpc_1675_23.
12.Negri GA, Andrade Junior AC, Cox MA, Marcatto de Abreu MF, Appenzeller S, Pagnano RG. Preoperative antibiotic prophylaxis and the incidence of surgical site infections in elective clean soft tissue surgery of the hand and upper limb: a systematic review and meta-analysis. J Orthop Traumatol. 2024 Jan 28;25(1):4. doi: 10.1186/s10195-024-00748-4.
13.Virmani A, Roy V, Meshram GG, Sural S. Surgical Antimicrobial Prophylaxis in Orthopedic Implant Surgeries: An Analysis of Practices, Outcomes, and Costs. Indian J Orthop. 2024 Dec 11;59(2):198-207. doi: 10.1007/s43465-024-01303-3.
14.Skender K, Machowska A, Singh V, Goel V, Marothi Y, Lundborg CS, et al. Antibiotic Use, Incidence and Risk Factors for Orthopedic Surgical Site Infections in a Teaching Hospital in Madhya Pradesh, India. Antibiotics (Basel). 2022 May 31;11(6):748. doi: 10.3390/antibiotics11060748.
15.Suranigi SM, Ramya SR, Sheela Devi C, Kanungo R, Najimudeen S. Risk factors, bacteriological profile and outcome of surgical site infections following orthopaedic surgery. Iran J Microbiol. 2021 Apr;13(2):171-177. doi: 10.18502/ijm.v13i2.5976.
16.Taherpour N, Mehrabi Y, Seifi A, Eshrati B, Hashemi Nazari SS. Epidemiologic characteristics of orthopedic surgical site infections and under-reporting estimation of registries using capture-recapture analysis. BMC Infect Dis. 2021 Jan 4;21(1):3. doi: 10.1186/s12879-020-05687-z.
17.Seidelman JL, Mantyh CR, Anderson DJ. Surgical Site Infection Prevention: A Review. JAMA. 2023 Jan 17;329(3):244-252. doi: 10.1001/jama.2022.24075.
18.Li T, Zhang H, Chan PK, Fung WC, Fu H, Chiu KY. Risk factors associated with surgical site infections following joint replacement surgery: a narrative review. Arthroplasty. 2022 May 1;4(1):11. doi: 10.1186/s42836-022-00113-y.
19.Li Z, Song L, Qin B, Li K, Shi Y, Wang H, et al. A predictive nomogram for surgical site infection in patients who received clean orthopedic surgery: a retrospective study. J Orthop Surg Res. 2024 Jan 5;19(1):38. doi: 10.1186/s13018-023-04473-2.
20.Moreira PAM, Gontijo TC, Colen GC, Morganti AC, Ulloa Gómez FI, Mourão PA, et al. Comparison of Cost Savings of Methods of Prevention of Orthopedic Implant-Associated Infection in Arthroplasty and Closed Fracture Surgery Patients. Antibiotics (Basel). 2025 Sep 5;14(9):900. doi: 10.3390/antibiotics14090900.
21.Kocur E, Rozentryt P, Głogowska-Gruszka A. Risk factors for surgical site infection in patients after implant-related orthopedic procedures. Przegl Epidemiol. 2021;75(3):332-346. doi: 10.32394/pe.75.30.
22.Redais C, Murison JC, Bazile F, de L'Escalopier N, Grosset A. Preoperative antibiotics reduce early surgical site infections after orthopaedic implant removal: a propensity-matched cohort study. J Hosp Infect. 2024 Jan;143:18-24. doi: 10.1016/j.jhin.2023.10.013.
23.Ahmed H, Mazhar F, Gilani A, Shah N, Azeem A, Rizwan M, et al. Antibiotic Prophylaxis in Orthopaedic Surgery: A Review and Institutional Experience. Cureus. 2025 Jul 6;17(7):e87385. doi: 10.7759/cureus.87385.
24.Tarabichi S, Parvizi J. Prevention of surgical site infection: a ten-step approach. Arthroplasty. 2023 Apr 8;5(1):21. doi: 10.1186/s42836-023-00174-7.
25.Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016 Dec;16(12):e276–e287. doi: 10.1016/S1473-3099(16)30398-X.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Pakistan Journal of Medicine and Dentistry

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/