Background/Objectives: While methicillin-resistant Staphylococcus aureus (MRSA) colonization is a known risk factor for surgical site infections, no definitive recommendations exist regarding preoperative S. aureus screening and decolonization protocols due to inconclusive evidence in Orthopedic Surgery. This study aimed to examine the correlation between preoperative MRSA colonization and postoperative infections in Total Knee Arthroplasty (TKA) patients. Methods: Data from 2005 to 2023 were collected from TriNetX, a global health research network, reviewing 237,360 unique patients. TKA patients were assigned under Current Procedural Terminology, while International Statistical Classification of Diseases Codes were used to identify preoperative comorbidities and postoperative complications. Demographic and analytical statistics were compared between MRSA-positive and control groups before and after propensity matching. Results: The MRSA-positive group had a significantly (p < 0.001) higher proportion of patients over 65 years (47.17% vs. 38.46%), obesity (41.76% vs. 34.67%), smoking disorders (33.36% vs. 19.73%), and diabetes (25.06% vs. 19.85%) compared to the control group. Postoperative complications were significantly (p < 0.001) more frequent in the MRSA-positive group, specifically periprosthetic joint infection (PJI) (4.11% vs. 0.79%, OR = 5.40), deep (0.12% vs. 0.01%, OR = 11.15) and superficial (0.37% vs. 0.09%, OR = 4.17) surgical site infections, and wound dehiscence (1.11% vs. 0.52%, OR = 2.13). The matched analysis confirmed significantly (p < 0.001) higher rates of PJI (4.39% vs. 1.18%, OR = 3.59). Conclusions: Our results illustrated preoperative colonization of MRSA as associated with an increased risk of wound-related complications. Surgeons and patients must consider preoperative MRSA colonization status when deciding if TKA is an optimal treatment option.

Objectives: The aim of this study was to determine the applicability of the Revised Risk Analysis Index (RAI-Rev) in orthopaedic trauma and compare the predictive discrimination for the RAI-Rev and the 5-Item Modified Frailty Index (mFI-5) for 30-day postoperative outcomes. Methods: Design: This is a retrospective cohort study. Setting: The American College of Surgeons National Surgical Quality Improvement database was used. Patient Selection: All patients aged 18 or older who underwent surgical treatment for forearm, humerus, pelvis, acetabulum, femur, tibia, and hindfoot fractures from 2015 to 2020 were included. Outcome: 30-day postoperative mortality, major complications, and wound complications consisting of surgical site infection, and wound dehiscence were measured. Results: A total of 206,352 patients met inclusion criteria. The mean age was 69 years, with 64.2% (n = 132,514) being female. Multivariate regression analysis showed that increasing frailty tiers in both RAI-Rev and mFI-5 were independent predictors of mortality, major complications, readmission, and wound complications. The cohort with the highest degree of frailty in both RAI-Rev and mFI-5 had the greatest risk of poor outcomes. RAI-Rev had significantly superior predictive discriminatory thresholds compared with mFI-5 for predicting 30-day mortality (C-statistic: RAI-Rev [0.84] and mFI-5 [0.67], P < 0.001), major complications (C-statistic: RAI-Rev [0.73] and mFI-5 [0.65], P < 0.001), and readmission (C-statistic: RAI-Rev [0.68] and mFI-5 [0.63], P < 0.001). However, mFI-5 outperformed RAI-Rev when predicting wound complications (C-statistic: RAI-Rev [0.52] and mFI-5 [0.55], P < 0.001). Conclusion: The RAI-Rev tool demonstrated superior predictability of postoperative morbidity, mortality, and readmission rates compared with mFI-5 but was less effective in predicting surgical site complications. These findings demonstrate the utility of RAI-Rev in anticipating postoperative complications in the setting of orthopaedic trauma, where optimizing surgical candidate selection is not always possible. Assessing the predicted morbidity and mortality through RAI-Rev enables surgeons to accurately identify patients at high risk of complications, which can further research investigation to mitigate this risk.

Pilon fractures often result from high energy mechanisms resulting in long-term morbidity and postoperative complications. While there is extensive literature investigating frailty scales as tools for preoperative risk stratification in orthopedic surgery, there is no literature regarding their use in fixation of pilon fractures. The objective of this study was to compare the predictive ability and discriminative accuracy of the Revised Risk Analysis Index (RAI-rev) and the 5-Item Modified Frailty (mFI-5) in 30-day postoperative outcomes following surgical fixation of pilon fractures. The ACS-NSQIP database was used to identify patients undergoing surgical fixation of pilon fractures from 2015 to 2020. Multivariate analysis was used to analyze the predictive ability of frailty status for 30-day postoperative outcomes. Discriminatory accuracy of frailty scales was assessed using receiver operating characteristic analysis. Significance was determined by p < 0.05. This study included 2935 patients, aged 33-59, of which 53 % (1562/2935) were male. The RAI-rev categorized 44.2 % (1296/2935) as normal, 44.6 % (1309/2935) as frail, and 11.2 % (330/2935) as severely frail. The mFI-5 was a significant predictor of major complications, readmission, and CDIV complications for severely frail patients and of eLOS, and NHD in both frail and severely frail patients. The RAI-rev had superior discriminative accuracy for most outcomes with good discriminative ability for NHD compared to mFI-5 (0.79 vs 0.74). This study demonstrated that compared to RAI-rev, mFI-5 is a significant predictor of postoperative complications after surgical fixation of pilon fractures, but RAI-rev had more accurate predictive ability when compared to mFI-5, most notable for NHD (AUC 0.79 vs 0.74). However, ROC values for both RAI (AUC 0.65-0.79) and mFI-5 (AUC 0.59-0.74) still fell below an AUC of 0.80 indicating that overall frailty is not a strong predictor of outcomes. These findings support the need for further research into preoperative risk assessment in pilon fracture patients. III - retrospective cohort study.