Authors: Ghulam Saadat, MD, Faizan Mazhar, PhD, Faran Bokhari, MD
Presenter: Ghulam Saadat, MD
Conference: Clinical Orthopedic Society
Date: September 2020


The purpose of this study is to evaluate the association between SWC grades and post-operative SSIs in emergent orthopedic patients.


The National Surgical Quality Improvement Program (NSQIP) database was queried for patients admitted between 2015 to 2017. All surgical cases with orthopedic surgery as the principal operative procedure were included. Cases identified as non-emergent or elective were excluded. Patients presented with SSIs at the time of surgery were also excluded. Patients were stratified by SWC grades and rates of superficial incisional infection, deep incisional infection, and organ/space infections were analyzed.


29,714 patients met the inclusion criteria and SSIs rate was 1.21 %. Overall, the rate of infection was not significantly different across the SWC grades (P = 0.11). Higher risk of SSIs was associated with increasing body mass index (BMI), worsening physical status as per American Society of Anesthesiologists (ASA) classification, history of severe COPD, steroid use, and longer length of hospital stay. Based on SWC, 86.5% of cases were classified as clean, 2.5% as clean/contaminated, 3.3% as contaminated, and 7.6% as dirty wounds. Rates of superficial, deep and organ/space SSI were 0.72%, 0.24%, and 0.25% respectively. After adjusting patients for age, BMI, ethnicity, gender, and pre-operative risk factors, SWC was not found to be an independent predictor of SSI.


Contrary to our hypothesis, the data showed that surgical wound classification is not significant in predicting surgical site infections in emergent orthopedic patients.