Analysis of risk factors, clinical outcomes, and medical costs for pelvic infection after open pelvic fractures: A seven-year retrospective observation study at a single trauma centre

Abstract

Background: Patients with unstable pelvic fractures usually die from haemorrhagic shock, whereas those with open pelvic fractures (OPF) die from pelvic infections (PIs) and pelvic sepsis (PS). We examined the clinical characteristics and results of PI in patients with OPFs. Methods: Patients with OPFs treated at our hospital between March 2016 and February 2023 were retrospectively reviewed. Factors associated with PI were identified by logistic regression analysis. Results: This study included 44 OPFs. In 50% (n=22) of these cases, the patients had PI. Gustilo grade-III ratio was much higher in the PI (81.8% [n=18]) than in the non-PI (36.4% [n=8]) group (p=0.008). Incidence of anorectal injury was higher in the PI group (68.2% [n=15] vs 13.6% [n=3], p=0.001). Multivariate logistic regression revealed age (odds ratio 1.02 [95% confidence interval 1.020–1.148], p=0.009), serum lactate level (1.319 [0.992–1.755], p=0.018), presence of Gustilo grade-III (7.467 [0.987–56.517], p=0.052), and anorectal injury (36.468 [3.107–427.991], p=0.004) as independent risk factors for PI. Hospitalisation stay, overall medical costs, and number of surgeries were 2.8 (84.0 vs 30.5 days, p=0.002), 2.9 (95.812 vs 33,224 USD, p=0.001), and 2.9 (13.0 vs 4.5, p<0.001) times higher in the PI than in the non-PI group, respectively. Conclusions: Age, serum lactate levels, Gustilo-Anderson grade-III status, and presence of anorectal injury are the risk factors for PI in patients with OPFs. PIs are associated with high medical costs. Early wound management, precise antibiotic therapy, and early-multidisciplinary approaches are necessary to treat PIs and prevent sepsis.