Implant Removal Due to Infection After Open Reduction and Internal Fixation: Trends and Predictors

Document Type : RESEARCH PAPER


1 Cooper Medical School of Rowan University, Camden, New Jersey, USA

2 Department of Orthopaedic Surgery, Cooper University Hospital, Camden, New Jersey, USA

3 Oliashirazi Institute at Marshall University, Huntington, West Virginia, USA


Background: Implant removal due to infection is one of the major causes failure following open reduction and internal 
fixation (ORIF). The aim of this study was to determine trends and predictors of infection-related implant removal 
following ORIF of extremities using a nationally representative database.
Methods: Nationwide Inpatient Sample data from 2006 to 2017 was used to identify cases of ORIF following upper and 
lower extremity fractures, as well as cases that underwent infection-related implant removal following ORIF. Multivariate 
analysis was performed to identify independent predictors of infection-related implant removal, controlling for patient 
demographics and comorbidities, hospital characteristics, site of fracture, and year. 
Results: For all ORIF procedures, the highest rate of implant removal due to infection was the phalanges/hand (5.61%), 
phalanges/foot (5.08%), and the radius/ulna (4.85%). Implant removal rates due to infection decreased in all fractures 
except radial/ulnar fractures. Tarsal/metatarsal fractures (odds ratio (OR)=1.45, 95% confidence interval (CI): 1.02-
2.05), and tibial fractures (OR=1.82, 95% CI: 1.45-2.28) were identified as independent predictors of infection-related 
implant removal. Male gender (OR=1.67, 95% CI: 1.49-1.87), Obesity (OR=1.85, 95% CI: 1.34-2.54), diabetes mellitus 
with chronic complications (OR=1.69, 95% CI: 1.13-2.54, P<0.05), deficiency anemia (OR=1.59, 95% CI: 1.14-2.22) 
were patient factors that were associated with increased infection-related removals. Removal of implant due to infection 
had a higher total charge associated with the episode of care (mean: $166,041) than non-infection related implant 
removal (mean: $133,110).
Conclusion: Implant removal rates due to infection decreased in all fractures except radial/ulnar fractures. Diabetes, 
liver disease, and rheumatoid arthritis were important predictors of infection-related implant removal. The study 
identified some risk factors for implant related infection following ORIF, such as diabetes, obesity, and anemia, that 
should be studied further to implement strategies to reduce rate of infection following ORIF.
Level of evidence: III


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