Thickness of the Subcutaneous Fat as a Risk Factor for Surgical Site Infection Following Fragility Hip Fracture Surgery

Abstract

Introduction Surgical site infection (SSI) following fragility hip fracture (FHF) surgery is associated with increased morbidity and mortality. Significance Prediction of patients at risk for SSI is fundamental. We aimed to determine whether subcutaneous radiographic fat measurement (SRM) is associated with increased SSI risk. Methods A retrospective case-control comparison of SRMs at 3 locations around the hip. Patients diagnosed with SSI in the first post-operative year were matched with age, gender, surgical year, Charlsons’ co-morbidity index score, and surgical type controls, not diagnosed with SSI, at a 1:2 ratio. Measurements included the distance between (1) the sourcil to skin surface (SS), (2) the tip of the greater trochanter to skin surface (TGTS), and (3) the most prominent lateral aspect of the greater trochanter to skin surface. Results 1430 patients were operated during the study period, of whom 45 patients presented with a diagnosis of SSI and compared to 90 controls. Infections occurred 27.4 ( ± 24.8) days following surgery. SRM significantly differed between groups, and all were higher in the study group; SS, 86.8 ± 25.5 cm vs 74.2 ± 15.3 cm; TGTS, 59.8 ± 26.3 cm vs 47.0 ± 15.8 cm; and LGTS, 45.4 ± 25.1 cm vs 33.2 ± 15.1 cm ( P = .003, .004, and .004, respectively). Intraclass correlation coefficients (intra-rater) were high for all measurements (.999 for all). Intraclass correlation coefficients (inter-rater) for SS, TGTS and LGTS were high, .749 (.663.815), .792 (.719.847) and .817 (.751.866), respectively. Conclusions SRMs were found to be a valid and reproducible tool for predicting high risk of SSI in geriatric patients sustaining FHFs. Level of Evidence III.

Acute Surgical Site Complications in Direct Anterior Total Hip Arthroplasty: Impact of Local Subcutaneous Tissue Depth and Body Mass Index

“…[ 11 ] However, another retrospective case-control study evaluating subcutaneous radiographic hip fat measurement in patients following fragility hip fracture fixation found significant differences in tissue measurements (all higher in the study group) between those who developed SSI and those who did not. [ 12 ]…”

Local adiposity may be a more reliable predictor for infection than body mass index following total knee arthroplasty: a systematic review

“…Recent investigations indicate that local adiposity is gaining momentum as a reliable predictor for postoperative infection. Subcutaneous fat thickness has been associated with increased rates of infection following abdominal surgery [ 22 ], spine surgery [ 7 ], hip fracture surgery [ 9 ], and colorectal surgery [ 10 ]. Therefore, it is a reasonable assessment that the same physiologic and mechanical factors which predispose to infection in these procedures may further the risk of infection following TKA.…”