Infection Risk Following Orthopaedic Sports Knee Surgery is Greater in Pediatric Patients With Allergic Disease History.

Abstract

Background: Allergic diseases are common in children and are risk factors for infections following orthopaedic surgery. However, their association with infection risk following knee surgery in pediatric populations is unknown. This study compared the risks of postoperative infection in children with and without a history of allergic disease (eczema [atopic dermatitis] or asthma) who underwent common orthopaedic sports knee surgeries.

Methods: A retrospective cohort study was conducted using the TriNetX database. Patients aged 10 to 18 who underwent anterior cruciate ligament (ACL) reconstruction (ACLR) or meniscal surgery, including meniscectomy, meniscal repair, and meniscal transplant, were organized into separate cohorts based on prior history of asthma or eczema and matched based on demographics and comorbidities. Outcomes were 90-day postoperative superficial soft tissue infection (SSTI), deep soft tissue infection (DSTI), sepsis, wound complication, pneumonia, urinary tract infection (UTI), and emergency department (ED) visit risks. Tests of significance (alpha=0.05) were performed, and risk ratios (RRs) with 95% confidence intervals were calculated.

Results: Patients with allergic diseases were more likely to be African American and obese. The risks of SSTI (1.3% vs. 0.4%; RR=3.182; P=0.0004) and sepsis (0.4% vs. 0%; P=0.002) in ACLR patients, and risks of SSTI (1.0% vs. 0.3%; RR=3.2; P=0.0007) and pneumonia (0.4% vs. 0%; P=0.0005) in meniscus surgery patients, were higher in patients with a history of eczema than without. Asthma was associated with a greater likelihood of SSTI (1.1% vs. 0.5%; RR=2.067; P=0.02) and sepsis (0.4% vs. 0%; P=0.002) in patients undergoing ACLR but not meniscus surgery. Prior diagnosis of either disease was associated with increased risk for ED visits following both ACLR and meniscus surgery. No significant differences in risk rates were noted between cohorts for DSTI, wound complications, and UTI.

Conclusions: Although overall risks were low, there were significantly greater risks of SSTI and ED visits following common knee sports surgeries in pediatric patients with a history of allergic disease than in those without.

Level of evidence: Level III.