Results of an Early Showering Protocol Following Orthopaedic Trauma Surgery.

Objectives: To evaluate the clinical outcomes of a standardized postoperative protocol permitting removal of post-operative dressings, showering, and cleansing of incisional wounds three days following fracture surgery.

Methods: Design: Retrospective Review.

Setting: Tertiary orthopaedic center.

Patient selection criteria: All adult patients, aged 18 years or older, operatively treated for fracture or other musculoskeletal trauma from September 2017 to September 2023 were screened for study eligibility. Patients with open fractures, revision surgery through surgical incisions created less than six weeks prior to the index procedure, immobilization (e.g., splints) precluding surgical wound access, known prior infection, acute traumatic local skin abrasions or lacerations, were excluded as these patients were not treated with the early showering protocol. Also excluded were patients with less than three-month follow up.

Outcome measures and comparisons: Outcome measures were re-operation within three months for wound or infectious complications and superficial surgical site infection treated with oral antibiotics.

Results: A total of 1,067 surgical cases were performed during the included time frame. 602 cases were excluded based on eligibility criteria, leaving 465 surgeries in 444 patients with a mean age of 59 years (range 18-95; 65% female). Mean follow-up was 11.7 months (SD 12.3; range 3.0-73.0). Re-operation for a wound or infectious complication occurred in 1.1% (5/465) of patients and superficial surgical site infection requiring antibiotic treatment occurred in an additional 1.1% of patients (5/465).

Conclusions: A protocol of dressing removal and showering at three days post-operatively over acute uncomplicated surgical wounds was associated with re-operation for deep infection in 1.1% of patients and superficial infection in 1.1% of patients supporting the safety of an early showering protocol.

Level of evidence: Level IV.