Surgical Site Infection at Amputation Stump Resulting in Prolonged Hospital Stay and Delayed Rehabilitation: A Study from Tertiary Care Level 1 Trauma Center

Background: Patients requiring amputation for lower limb crush injuries have been on the rise, especially in developing countries. Post-amputation rehabilitation is a major challenge in these patients. Physical rehabilitation in the form of early prosthesis to make an individual ambulatory plays a major role in crush injury patient; for that, good, healthy stump is mandatory. Surgical site infection is the leading cause of prolonged hospital stay leading to late ambulation.

Materials: With an aim to evaluate the rate of surgical site infection (SSI) in admitted patient prolonging  length of hospital stay, we conducted a prospective study in patients undergoing lower limb amputations following trauma and studied total 100 lower limb amputations below the hip joint. The study was carried out between January 2018 and May 2019 at the JPN Apex Trauma Centre, AIIMS, New Delhi. Patients requiring immediate amputation for lower extremity trauma were included in the study. All patients underwent amputations as per standard technique and were given prophylactic antibiotics initially, then followed by culture-based antibiotics as per hospital policy. All surgical site infections in amputation stump were noted and data was collected to evaluate increased length of stay in those patients compared to the patient without SSI. The factors responsible for surgical site infections were studied in detail. The factors like delay in hospital arrival, under resuscitation, low hemoglobin, low protein, associated comorbidity, association with other injuries, and ICU stay were included. Other variables were compared using unpaired t-test/Mann Whitney test, and a p value of  <0.05 was considered statistically significant.

Results: A total of 100 patients were recruited prospectively. On preliminary analysis, there was significant difference found in length of hospital stay in patients with surgical site infection compared to other group without surgical site infection.

Conclusion: SSIs significantly increase hospital stays, leading to delayed rehabilitation in amputees.