Predictors of surgical site infection/fracture related infection after open tibial fracture

Le résumé fourni par la source

Objectives: To develop and internally validate leakage-robust landmark models to estimate 12-month fracture-related infection (FRI) risk after open tibial fracture at admission and postoperative day 3 (POD3). Methods: In this single-center retrospective cohort, adults with open tibial fractures treated with limb salvage between January 2023 and June 2024 were included. Definite 12-month FRI was adjudicated using the international FRI consensus definition. Two landmark models were prespecified: admission and postoperative day 3 (POD3). Predictors included injury severity, contamination, host and physiologic factors, antibiotic timing, and, at POD3, early clinical course, routine laboratory results, debridement timing, and soft-tissue coverage status. Elastic net-penalized logistic regression with restricted cubic splines was used. Missing data were addressed with multiple imputation nested within 1,000-bootstrap internal validation. Performance was assessed by AUC, Brier score, calibration, and decision curve analysis. Results: Among 913 patients, 125 (13.7 %) developed FRI. The admission model achieved an AUC of 0.77 and Brier score of 0.097. The POD3 model improved performance (AUC 0.82; Brier 0.089) and showed slightly greater net benefit across 5-25 % thresholds. Conclusions: Landmark models provided internally validated 12-month FRI risk estimates at admission and POD3, with modest improvement after POD3 updating. External validation and recalibration are required to evaluate its potential clinical deployment.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.