research article Surgical Site Infections at Donor and Recipient Sites in Patients with Iliac Crest Harvesting For Autologous Bone Grafting - A Pilot Evaluation
Ines Unterfrauner1, Maurits Olthof1, Peter Jans 2, Regula Schüpbach3, Michael Betz1, İlker Uçkay3,4*
1 Orthopedic Department, Balgrist University Hospital, Zurich, Switzerland
2 Medical Informatics Service, Balgrist University Hospital, Zurich, Switzerland
3 Unit of Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
4 Infection Control, Balgrist University Hospital, Zurich, Switzerland
* Corresponding author : İlker Uçkay, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
Received Date: 09 December 2022
Accepted Date: 13 December 2022
Published Date: 15 December 2022
Citation: Unterfrauner I, Olthof M, Jans P, Schüpbach R, Betz M, et al. (2022) Surgical Site Infections at Donor and Recipient Sites in Patients with Iliac Crest Harvesting For Autologous Bone Grafting - A Pilot Evaluation. Ann Case Report. 7: 1087. DOI: https://doi.org/10.29011/2574-7754.101087
Abstract
Surgeons harvest the iliac crest for bone grafting. The epidemiology of surgical site infections (SSI) associated with this procedure at the donor, or recipient site, is unknown. We perform a retrospective pilot evaluation of adult patients undergoing first-time orthopedic surgery at the Balgrist University Hospital between 2014-2019. We excluded patients with infection at the index surgery, diabetic foot surgeries, superficial SSIs, and revision surgeries. We included 20,088 episodes of primary orthopedic surgery, of which 467 with iliac crest bone sampling (467/20,088; 2%). Only two iliac sites (2/467; 0.4%) become infected. In contrast, surgeries with iliac crest sampling yielded more SSIs at the recipient site than those without (1.9% vs. 0.8%; χ2-test; p<0.01). These patients equally revealed more co-morbidities such as a longer duration of surgery (median 127 vs. 79 minutes), when compared to the general orthopedic population. In multivariate logistic regression analysis with the outcome “ SSI at the recipient site”, the iliac harvesting was independently associated with deep SSIs requiring surgical revision (odds ratio 2.1; 95% confidence interval 1.1-4.2). In our pilot evaluation with 20,088 primary orthopedic surgeries, the SSI risk of the iliac harvest site was low. In contrast, surgeries with supplementary iliac crest harvesting revealed a higher SSI risk than the general orthopedic population, potentially due to a mix of local independent risks of grafting together with a prolonged surgery time.
Keywords : Autologous bone grafting; Deep surgical site infections; Epidemiology; Iliac crest harvesting; Revision surgery
References
- Bauer TW, Muschler GF (2000) Bone graft materials: an overview of the basic science. Clin Orthop Relat Res 371:10-27.
- Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: A systematic review. Injury 42: 3-15.
- Kim DH, Rhim R, Li L, Martha M, Swaim BH, et al (2009) Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 9: 886-892.
- Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, et al (2014) Incidence of donor site morbidity following harvesting from iliac crest or RIA graft. Injury 45: 116-120.
- Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27: 97-132.
- Pirris SM, Nottmeier EW, Kimes S, O'Brien M, Rahmathulla G (2014) A retrospective study of iliac crest bone grafting techniques with allograft reconstruction: do patients even know which iliac crest was harvested? Clinical article. J Neurosurg Spine 21: 595-600.
- Hernigou P, Desroches A, Queinnec S, Lachaniette CHF, Poignard A (2014) Morbidity of graft harvesting versus bone marrow aspiration in cell regenerative therapy. Int Orthop 38: 1855-1860.
- Swan MC, Goodacre TE (2006) Morbidity at the iliac crest donor site following bone grafting of the cleft alveolus. Br J Oral Maxillofac Surg 44: 129-133.
- Palmer W, Crawford-Sykes A, Rose REC (2008) Donor site morbidity following iliac crest bone graft. West Indian Med J 57: 490-492.
- Silber JS, Anderson DG, Daffner SD, Brislin BT, Leland JM (2003) Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 28: 134-139.