Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study

Abstract

BackgroundGeriatric hip fracture is a common type of osteoporotic fracture with high mortality and disability; surgical site infection (SSI) can be a devastating complication of this injury. By far, only a few studies identified easily remediable factors to reduce infection rates following hip fracture and less researches have focused on geriatric patients. The objective of this study was to identify potentially modifiable factors associated with SSI following geriatric hip fracture surgery.MethodsThis retrospective, multicenter study involves three level I hospitals. A total of 1240 patients (60 years or older) underwent hip surgery with complete data were recruited between January 2016 and June 2018. Demographics information, medications and additional comorbidities, operation-related variables, and laboratory indexes were extracted and analyzed. Receiver operating characteristic (ROC) analysis was performed to detect the optimum cut-off value for quantitative data. Univariate and multivariate logistic analysis model were performed respectively to identify the independent predictors.ResultsNinety-four (7.58%) patients developed SSI in this study, and 76 (6.13%) had superficial infection, while 18 (1.45%) were diagnosed with deep infection. Results of univariate and multivariate analysis showed age > 79 years (OR, 2.60; p < 0.001), BMI > 26.6 kg/m2 (OR, 2.97; p < 0.001), operating time > 107 min (OR, 2.18; p = 0.001), and ALB < 41.6 g/L (OR, 2.01; p = 0.005) were associated with an increased incidence of SSI; drainage use (OR, 0.57; p = 0.007) could reduce the incidence of wound infection for patients after geriatric hip fracture.ConclusionAccurate modifiable variables, operating time > 107 min, serum albumin < 41.6 g/L, BMI > 26.6 kg/m2, and age > 79 years could be applied to distinguish geriatric patients with high-risk of postoperative surgical site infection.

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

“…32,33 The current study revealed that a serum albumin concentration < 35 g/L is a risk factor for SSI after intertrochanteric fractures. The results of our study were similar to that of Ma et al, 6 in which hypoalbuminemia increased the risk of SSI after hip fractures. Therefore, we should pay more attention to the nutritional status of patients with a hip fracture for the timely nutritional supplementation may reduce the incidence of poor outcomes.…”

“…5 Surgical site infection (SSI) is a challenging postoperative complication for the patient and hospital, the rate of which following hip fractures is between 2.7% and 14.9%. [6][7][8] It not only leads to more hospital stay, poor functional outcomes, and greater costs but also results in a substantially increased mortality risk. 9,10 A variety of risk factors of SSI were documented, including age, comorbidities, obesity, the experience of the surgeon, haematoma, surgical duration, increased duration of anaesthesia, body mass index (BMI), current smoking, preoperative hospital stay, serum albumin, warfarin treatment, and so forth.…”

Do direct oral anticoagulants (DOACs) cause delayed surgery, longer length of hospital stay, and poorer outcome for hip fracture patients?

“…One earlier study has investigated DOAC-users' risk of reoperation due to wound ooze and found no relation to surgical delay [30]. On the other hand, when studying hip fracture patients not accounting for chronic anticoagulation, surgical delay has been found to be a risk factor for wound infections [28,33]. The association between wound ooze and longer LOS found in our study might have implications for health costs and patient treatment following a hip fracture.…”

“…The prevalence and risk factors for surgical site infections is sparsely studied in the geriatric hip fracture population even though high age has been identified as a potential risk factor for such infections [33]. Our study revealed wound oozing five times more frequently among DOAC-users than patients without anticoagulation.…”

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

“…Caplan et al ( 36 ) found that HBR, compared to IR, reduces the risk of delirium by 83%. Previous studies showed associations between hypoalbuminemia with the development of infections including surgical site infection ( 37 ), sepsis ( 35 ), and the development of delirium ( 14 , 38 ). Galivanche et al ( 39 ) found that infectious diseases, including sepsis, pneumonia, and urinary tract infections, and delirium were risk factors for the development of pressure sores.…”