Analysis of risk factors for postoperative wound infection in open hand injuries by propensity score matching

Liu Xiang; Yan Wei

doi:10.3969/j.issn.1009-4237.2025.03.012

Abstract：Objective To investigate the distribution of pathogenic bacteria in postoperative wound infec-tion of open hand injuries,and to analyze the risk factors based on propensity score matching(PSM).Methods A retrospective analysis was conducted on the clinical data of 1,875 patients with open hand injuries who underwent surgical treatment at Xinyang Central Hospital from Jan.2019 to Dec.2022,including 1,249 males and 626 fe-males,and the age range was 18 to 78 years,with an average of 42.4 years.There were 790 cases of compression and rolling injuries,556 cutting injuries,342 degloving injuries,155 stabbing injuries,and 32 others.According to the occurrence of wound infection after surgery,patients were divided into infection group(83 cases)and non-infec-tion group(1,792 cases).The pathogenic bacteria were automatically identified using fully automatic microbiologi-cal analyzer.The PSM method was used to match baseline covariates between the infected and non-infected groups,including gender,age,body mass index(BMI),underlying diseases,or cause of injury.After PSM,the risk factors for postoperative wound infection in open hand injuries were analyzed using univariate and multivariate Logistic re-gression analysis.Results The incidence of postoperative wound infection in patients with open hand injuries was 4.43%(95%CI:0.349-0.536).The main pathogens were Pseudomonas aeruginosa,Escherichia coli,Staphylococ-cus aureus,and Staphylococcus epidermidis,with a relatively high proportion of Gram-negative bacteria(53.7%).After PSM,a total of 83 pairs of patients were successfully matched between the infected and non-infected groups,and there was no statistically significant difference in gender,age,BMI,comorbidities,or cause of injury between the two groups(P>0.05).The results of univariate analysis showed statistically significant differences in terms of time from injury to surgery,operation time,residual dirt at the wound,and postoperative hypoalbuminemia between the two groups(all P<0.05).Multivariate analysis further showed that time from injury to surgery≥6 h(OR=2.895,95%CI:1.452-5.771),operation time≥3 h(OR=1.802,95%CI:1.185-2.741),residual dirt at the wound(OR=4.076,95%CI:1.909-8.702),and postoperative hypoalbuminemia(OR=1.660,95%CI:1.062-2.596)were all inde-pendent risk factors for postoperative wound infection of open hand injuries(P<0.05).Conclusion Gram negative bacteria(53.7%)are more common pathogens in postoperative wound infections of open hand injuries.After adjus-ting for confounding factors during the baseline period using the PSM method,the time from injury to surgery≥6 h,surgery time≥3 h,residual wound dirt,and postoperative hypoalbuminemia are all independent risk factors for post-operative wound infections of open hand injuries.