SLR - August 2020 - Zoran Rakonjac

Seasonal Effect on the Incidence Of Post-Operative Wound Complications After Trauma-Related Surgery of the Foot, Ankle, and Lower Leg

Reference: Sanders RK, Hul M, Kistemaker RM, Schepers T. Seasonal Effect on the Incidence of Post-Operative Wound Complications After Trauma-Related Surgery of the Foot, Ankle, And Lower Leg Arch Orthop Trauma Surg. 2020 Mar 9. doi: 10.1007/s00402-020-03395-6.

Scientific Literature Review

Reviewed By: Zoran Rakonjac, DPM
Residency Program: VA Puget Sound Health Care System – Seattle, WA

Podiatric Relevance: Infections and wound dehiscence continue to be among the most common complications following lower extremity trauma surgery. Traumatic lower extremity injuries tend to occur more often in summer months during which time people are more active. Some recent studies have suggested that environmental factors such as season of the year can affect the incidence of post-operative wound complications. The aim of this study was to identify whether seasons are a significant predictor for wound complications.

Methods: Retrospective cohort study included all participants undergoing trauma-related surgery of the foot, ankle, or lower leg between September 2015 and March 2019 at a single level-1 trauma center in the Netherlands. Procedures were divided into two groups: (one) surgeries performed in Summer (June-August) and other seasons (Sep-May). Total number of surgical wound complications (fracture related infections and/or wound dehiscence) were compared. 

Results: The study included 599 procedures primarily in the rearfoot (47.6 percent). Average age of the patient was 46 and 60.8 percent of the patients were male. Total number of wound complications was 43 (7.2 percent). There were no differences found in wound complications between surgeries performed in the summer months versus other seasons (p = 0.0096) 

Conclusions: Previous literature on seasonality in lower extremity trauma surgery has led to different conclusions. Some studies, specifically large national retrospective study by Anthony et al. found that incidence of wound complications to be highest in the summer. Various theories exist to support increased complications during summer. One theory is that skin colonization by gram-positive and gram-negative bacteria tend to have higher incidence in the summer months. Another hypothesis is the “July-effect”, description for the start of academic year when new (inexperienced) surgeons start their training. However, other studies found no seasonal differences in complications rates in orthopedic surgery. Surgical wound complications following lower extremity trauma surgery are likely multifactorial, therefore, it would be beneficial for future studies to identify specific climate/season related factors that could influence surgical wound healing.  

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