PURPOSE Although several small-scale studies have reported risk factors for surgical site infection (SSI) after high tibial osteotomy (HTO), no study has collectively analysed risk factors in a large cohort. The present study aimed to clarify the risk factors for SSI after HTO using a national database. METHODS Data of inpatients who underwent HTO from 2010 to 2017 were obtained from the Diagnosis Procedure Combination database in Japan. Outcome measures were the incidence of SSI and deep SSI after HTO. Associations between SSI and patient data were examined with multivariable logistic regression analysis. RESULTS Among 12,853 patients who underwent HTO, 195 developed SSI (1.52%) and 50 developed deep SSI (0.39%). Univariate analysis showed that male sex, smoking, and longer anaesthesia duration were associated with higher incidences of SSI, whereas a primary diagnosis of osteonecrosis and use of natural bone grafts were associated with lower incidences. In multivariable analysis, SSI was positively associated with male sex, anaesthesia duration longer than 210 min (vs. 150-210 min), and use of artificial bone graft (vs. natural bone graft). SSI was negatively associated with age ≤ 49 years (vs. 50-59 years) and a primary diagnosis of osteonecrosis (vs. osteoarthritis). CONCLUSION The present study revealed novel risk factors for SSI after HTO that previous studies have failed to find, including use of artificial bone graft and longer anaesthesia duration; primary diagnosis of osteonecrosis and younger age were novel protective factors. These findings will help surgeons assess risks of SSI after HTO in individual patients. LEVEL OF EVIDENCE III.

中文翻译：

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高胫骨截骨术后，骨移植类型和初步诊断与医院手术部位感染相关：国家数据库分析。

目的尽管有几项小规模研究报告了胫骨截骨术（HTO）后发生手术部位感染（SSI）的危险因素，但尚无一项研究能对大型人群的危险因素进行集体分析。本研究旨在使用国家数据库明确HTO后SSI的危险因素。方法从日本的诊断程序组合数据库中获得2010年至2017年接受HTO治疗的住院患者数据。结果是HTO后SSI和深SSI的发生率。通过多变量logistic回归分析检查了SSI与患者数据之间的关联。结果在接受过HTO的12,853例患者中，有195例发展为SSI（1.52％），有50例发展为深SSI（0.39％）。单因素分析表明，男性，吸烟和较长的麻醉持续时间与SSI发生率较高相关，而对骨坏死的初步诊断和使用天然骨移植物的发生率较低。在多变量分析中，SSI与男性，麻醉时间长于210分钟（相对于150-210分钟）以及使用人工骨移植（相对于自然骨移植）呈正相关。SSI与年龄≤49岁（相对于50-59岁）和骨坏死的初步诊断（相对于骨关节炎）呈负相关。结论本研究揭示了先前研究未能发现的HTO后SSI的新危险因素，包括使用人造骨移植物和更长的麻醉时间。骨坏死的早期诊断和较年轻的年龄是新的保护因素。这些发现将有助于外科医生评估个别患者HTO后发生SSI的风险。证据级别III。