Impact of Smoking as a Risk Factor for Surgical Site Infections After Open Reduction and Internal Fixation (ORIF) of Distal Radius Fractures

TL;DR

Smoking increases the risk of infections after surgery to fix wrist fractures, with smokers having more than three times the risk compared to non-smokers.

Contribution

This study provides empirical evidence that smoking is a strong independent risk factor for postoperative infections after distal radius fracture surgery.

Findings

Smokers had a 12.58% infection rate compared to 3.03% in non-smokers.

Smoking was an independent predictor of infection with an adjusted odds ratio of 3.52.

Prolonged surgery and poor glycemic control also increased infection risk.

Abstract

Background: Smoking is a recognized risk factor for postoperative infections, but its specific impact on infection rates following distal radius fracture fixation remains underexplored.

Objective: To compare the postoperative infection rates following open reduction and internal fixation (ORIF) of distal radius fractures in smokers versus non-smokers.

Methodology: This retrospective cohort study was conducted at the Mardan Medical Complex, Mardan, Pakistan, over a three-year period (August 2020-July 2023). A total of 640 patients aged ≥18 years who underwent ORIF for distal radius fractures and had documented smoking status and 1-year postoperative follow-up were included. Patients were divided into smokers (n = 310) and non-smokers (n = 330). Data on demographics, comorbidities, surgical details, and microbiologically confirmed postoperative infections were analyzed. Chi-square test and multivariate logistic regression were used for statistical analysis in the IBM SPSS Statistics version 26.

Results: Infection rates were significantly higher among smokers (39 patients; 12.58%) compared to non-smokers (10 patients; 3.03%) (p < 0.001). Early infections (<30 days) occurred in 20 smokers (6.45%) and six non-smokers (1.82%), while late infections (≥30 days) were reported in 19 smokers (6.13%) and 4 non-smokers (1.21%). Multivariate logistic regression confirmed smoking as an independent predictor of postoperative infection, with smokers having more than a threefold increased risk compared to non-smokers (adjusted OR = 3.52, 95% CI: 1.68-7.37, p < 0.001). Poor glycemic control (HbA1c ≥7) also doubled the risk of infection (adjusted OR = 2.14, 95% CI: 1.01-4.55, p = 0.046). Additionally, prolonged operative time (>90 minutes) was associated with approximately a twofold increased risk (adjusted OR = 2.02, 95% CI: 1.03-3.97, p = 0.040).

Conclusion: Smoking significantly increases the risk of postoperative infections following ORIF of distal radius fractures.