{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:46:17Z","timestamp":1790635577971,"version":"4.1.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T00:00:00Z","timestamp":1668124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004331","name":"Johnson and Johnson","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004331","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Surgical site infection constitutes a serious complication in the healing process of bone fractures and has been associated with increases in medical resource use and healthcare costs. This study evaluates the economic impact of surgical site infection in tibial fractures in a Spanish cohort. It is a retrospective, single-centre, comparative cohort study of patients with tibial fractures with longitudinal follow-up for up to 18 months post-surgery. Included patients (n = 325) were adults, with tibial fracture, either isolated or polyfracture, or polytrauma with an Injury Severity Score &gt;15. Patients had been surgically treated within 30 days of the tibial fracture by external or internal fixation, or external followed by internal fixation. Most patients (84.9%) had an American Society of Anaesthesiology score of 1\u20132. 20% of the patients had one open tibial fracture, 12.3% had polytrauma, and 20% had multiple fractures. Most patients were treated with a nail (41.8%) or a plate (33.8%). 56 patients (17.2%) developed surgical site infection. Patients with infection had significantly higher hospital length of stay (34.9 vs 12.0 days; p&lt;0.001; +191%), readmissions (1.21 vs 0.25; p&lt;0.001; +380%) and mean operating theatre time (499 vs 219 min; p&lt;0.001; +128%) than patients without infection. Mean length of stay in intensive care did not significantly increase with infection (2.8 vs 1.7 days; p = 0.25). Total in-hospital costs for patients with infection increased from \u20ac7,607 to \u20ac17,538 (p&lt;0.001; +131%). Overall, infections were associated with significantly increased healthcare resource use and costs. Preventive strategies to avoid infections could lead to substantial cost savings.<\/jats:p>","DOI":"10.1371\/journal.pone.0277482","type":"journal-article","created":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T18:26:33Z","timestamp":1668191193000},"page":"e0277482","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Healthcare resource use and costs related to surgical infections of tibial fractures in a Spanish cohort"],"prefix":"10.1371","volume":"17","author":[{"given":"Mariano","family":"Barr\u00e9s-Cars\u00ed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Navarrete-Dualde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Quintana Plaza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Escalona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4516-0441","authenticated-orcid":true,"given":"Christian","family":"Muehlendyck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-249X","authenticated-orcid":true,"given":"Thibaut","family":"Galvain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1335-2681","authenticated-orcid":true,"given":"Jos\u00e9","family":"Baeza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Balfag\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,11]]},"reference":[{"issue":"1","key":"pone.0277482.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jhin.2017.03.004","article-title":"Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries","volume":"96","author":"JM Badia","year":"2017","journal-title":"J Hosp Infect."},{"issue":"15","key":"pone.0277482.ref002","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.2106\/JBJS.15.00894","article-title":"Risk Factors for Deep Infection Following Plate Fixation of Proximal Tibial Fractures","volume":"98","author":"M Parkkinen","year":"2016","journal-title":"J Bone Jt Surg"},{"issue":"14","key":"pone.0277482.ref003","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1056\/NEJMra035415","article-title":"Treatment of Infections Associated with Surgical Implants","volume":"350","author":"RO Darouiche","year":"2004","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0277482.ref004","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1089\/wound.2014.0531","article-title":"Current Concepts and Ongoing Research in the Prevention and Treatment of Open Fracture Infections","volume":"4","author":"GD Hannigan","year":"2015","journal-title":"Adv Wound Care"},{"key":"pone.0277482.ref005","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1016\/j.injury.2015.08.009","article-title":"Surgical management of infected non-unions: An update","volume":"46","author":"NK Kanakaris","year":"2015","journal-title":"Injury [Internet]"},{"issue":"7","key":"pone.0277482.ref006","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0020-1383(98)00125-9","article-title":"The epidemiology of open long bone fractures","volume":"29","author":"CM Court-Brown","year":"1998","journal-title":"Injury"},{"issue":"4","key":"pone.0277482.ref007","doi-asserted-by":"crossref","first-page":"453","DOI":"10.2106\/00004623-197658040-00004","article-title":"Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses","volume":"58","author":"RB Gustilo","year":"1976","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"pone.0277482.ref008","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1186\/s12891-017-1847-z","article-title":"Infection following fractures of the proximal tibia\u2013a systematic review of incidence and outcome","volume":"18","author":"Committee TRAUMA of the AGA-Society for Arthroscopy and Joint Surgery","year":"2017","journal-title":"BMC Musculoskelet Disord."},{"issue":"6","key":"pone.0277482.ref009","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/00005131-200108000-00006","article-title":"Rates and Odds Ratios for Complications in Closed and Open Tibial Fractures Treated With Unreamed, Small Diameter Tibial Nails: A Multicenter Analysis of 467 Cases","volume":"15","author":"C Gaebler","year":"2001","journal-title":"J Orthop Trauma"},{"issue":"9009","key":"pone.0277482.ref010","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/S0140-6736(96)90606-6","article-title":"Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial","volume":"347","author":"H Boxma","year":"1996","journal-title":"Lancet Lond Engl"},{"issue":"12","key":"pone.0277482.ref011","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/j.injury.2011.10.015","article-title":"Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification","volume":"42","author":"C Papakostidis","year":"2011","journal-title":"Injury"},{"issue":"5","key":"pone.0277482.ref012","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.ajic.2008.12.010","article-title":"Surgical site infection: Incidence and impact on hospital utilization and treatment costs","volume":"37","author":"G de Lissovoy","year":"2009","journal-title":"Am J Infect Control [Internet]"},{"issue":"1","key":"pone.0277482.ref013","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jhin.2013.09.012","article-title":"Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital","volume":"86","author":"PJ Jenks","year":"2014","journal-title":"J Hosp Infect [Internet]"},{"issue":"2","key":"pone.0277482.ref014","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jhin.2006.01.015","article-title":"Deep wound infection after proximal femoral fracture: consequences and costs","volume":"63","author":"TCB Pollard","year":"2006","journal-title":"J Hosp Infect [Internet]"},{"issue":"4","key":"pone.0277482.ref015","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1089\/sur.2014.045","article-title":"Hospital Cost of Staphylococcal Infection after Cardiothoracic or Orthopedic Operations in France: A Retrospective Database Analysis","volume":"16","author":"A Schmidt","year":"2015","journal-title":"Surg Infect."},{"issue":"4","key":"pone.0277482.ref016","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jcot.2015.04.004","article-title":"Surgical site infection in orthopedic trauma: A case\u2013control study evaluating risk factors and cost.","volume":"6","author":"RV Thakore","year":"2015","journal-title":"J Clin Orthop Trauma [Internet]"},{"issue":"4","key":"pone.0277482.ref017","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1308\/003588415X14181254788845","article-title":"Cost of infection after surgery for intracapsular fracture of the femoral neck","volume":"97","author":"M Wijeratna","year":"2015","journal-title":"Ann R Coll Surg Engl [Internet]"},{"issue":"8","key":"pone.0277482.ref018","doi-asserted-by":"crossref","first-page":"e035404","DOI":"10.1136\/bmjopen-2019-035404","article-title":"The economic burden of infections following intramedullary nailing for a tibial shaft fracture in England","volume":"10","author":"T Galvain","year":"2020","journal-title":"BMJ Open [Internet]"},{"issue":"5","key":"pone.0277482.ref019","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s00264-016-3337-6","article-title":"The cost of infection in severe open tibial fractures treated with a free flap","volume":"41","author":"UK Olesen","year":"2017","journal-title":"Int Orthop."},{"issue":"6","key":"pone.0277482.ref020","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.injury.2017.03.030","article-title":"Infection after fracture fixation of the tibia: Analysis of healthcare utilization and related costs","volume":"48","author":"WJ Metsemakers","year":"2017","journal-title":"Injury [Internet]"},{"issue":"SUPP_16","key":"pone.0277482.ref021","first-page":"18","article-title":"Income and costs of treating tibial osteomyelitis in the uk: a comparison of limb salvage versus amputation","volume":"97-B","author":"J Kendall","year":"2015","journal-title":"Orthop Proc [Internet]"},{"issue":"1","key":"pone.0277482.ref022","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1136\/ip.7.1.10","article-title":"An overview of the injury severity score and the new injury severity score.","volume":"7","author":"M Stevenson","year":"2001","journal-title":"Inj Prev [Internet]"},{"issue":"1","key":"pone.0277482.ref023","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s13049-017-0400-2","article-title":"Does the applied polytrauma definition notably influence outcome and patient population?\u2014a retrospective analysis","volume":"25","author":"S Frenzel","year":"2017","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"2","key":"pone.0277482.ref024","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.injury.2011.06.029","article-title":"AIS>2 in at least two body regions: A potential new anatomical definition of polytrauma","volume":"43","author":"N Butcher","year":"2012","journal-title":"Injury [Internet]"},{"key":"pone.0277482.ref025","volume-title":"StatPearls [Internet]","author":"DJ Doyle","year":"2020"},{"key":"pone.0277482.ref026","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and Dislocation Classification Compendium\u20142018. International Comprehensive Classification of Fractures and Dislocations Committee","volume":"32","author":"E Meinberg","year":"2018","journal-title":"J Orthop Trauma [Internet]"},{"issue":"1","key":"pone.0277482.ref027","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13561-015-0045-7","article-title":"Statistical models for the analysis of skewed healthcare cost data: a simulation study","volume":"5","author":"AS Malehi","year":"2015","journal-title":"Health Econ Rev."},{"key":"pone.0277482.ref028","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ijsu.2015.02.004","article-title":"Intramedullary nail versus plate treatments for distal tibial fractures: A meta-analysis","volume":"16","author":"J Yu","year":"2015","journal-title":"Int J Surg [Internet]"},{"issue":"12","key":"pone.0277482.ref029","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1016\/j.injury.2015.09.028","article-title":"The use of gentamicin-coated nails in complex open tibia fracture and revision cases: A retrospective analysis of a single centre case series and review of the literature","volume":"46","author":"WJ Metsemakers","year":"2015","journal-title":"Injury"},{"issue":"5","key":"pone.0277482.ref030","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00264-014-2293-2","article-title":"Systematic review and meta-analysis of the additional benefit of local prophylactic antibiotic therapy for infection rates in open tibia fractures treated with intramedullary nailing","volume":"38","author":"J Craig","year":"2014","journal-title":"Int Orthop [Internet]"},{"key":"pone.0277482.ref031","doi-asserted-by":"crossref","first-page":"A579","DOI":"10.1016\/j.jval.2017.08.1024","article-title":"The Resource And Cost Consequences Of Using Antibiotic Coated Intramedullary Nails Compared To Non-Coated Nails In Open Tibia Fractures Across Four European Centres","volume":"20","author":"H Taylor","year":"2017","journal-title":"Value Health"},{"issue":"8","key":"pone.0277482.ref032","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017","volume":"152","author":"SI Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg [Internet]"},{"issue":"3","key":"pone.0277482.ref033","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: A consensus on definition from an international expert group","volume":"49","author":"Metsemakers Wj","year":"2018","journal-title":"Injury [Internet]"},{"issue":"1","key":"pone.0277482.ref034","first-page":"8","article-title":"Diagnosing Fracture-Related Infection: Current Concepts and Recommendations","volume":"34","author":"GAM Govaert","year":"2020"},{"key":"pone.0277482.ref035","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/978-0-387-87959-8_5","volume-title":"Applying Quantitative Bias Analysis to Epidemiologic Data [Internet]","author":"TL Lash","year":"2009"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277482","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T18:26:56Z","timestamp":1668191216000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0277482"}},"subtitle":[],"editor":[{"given":"Osama","family":"Farouk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,11]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0277482","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,11]]}}}