Mortality, functional outcomes and quality of life after hip fractures complicated by infection: a case control study

Abstract

Abstract. Introduction: Infection is a detrimental complication of operatively treated hip fractures. The objective of this retrospective case-control study was to evaluate the mortality, the physical function and the quality of life of hip fractures complicated with infection and determine risk factors for deep infection in hip fractures. Patients and methods: All patients with hip fractures (31A and 31B OTA/AO) that were operatively managed over a 10-year period that subsequently developed deep infection were included in the study. Thirty-nine patients met the inclusion criteria. These patients were compared with a matched control group of 198 patients without infection. Minimum follow-up was 1 year. Mortality, Barthel index score, EQ-5D-5L, Parker mobility score and visual analogue scale (VAS) pain score were compared between groups. Results: Mortality at 1 month was 20.5 % and 43 % at 1 year. Half of the infections were acute and 28 % were polymicrobial. Mortality was greater in the infection group (43 % vs. 16.5 %, p<0.0014), and Barthel index was inferior in the infection group (14 vs. 18, p<0.0017) compared to control group. Logistic regression analysis revealed that time from admission to surgery was a negative factor that predisposed to infection. Conclusions: Patients complicated with infection after a hip fracture have higher mortality and inferior functional results. Delay from admission to surgery predisposes to infection.

Associated Factors of Functional Ability in Older Persons Undergoing Hip Surgery Immediately Post-Hospital Discharge: A Prospective Study

“…Adverse health outcomes during hospitalization and post-hospital discharge did not predict poor functional ability at immediate post-hospital discharge, which differed from prior studies [45]. In the present study, although some adverse health outcomes were documented during hospital admission, no severe adverse events that required transfer to the intensive care unit occurred.…”

“…However, another study reported that there was a significant association between adverse health outcomes-postoperative complications, infections, pneumonia, urinary tract infections, delirium, skin problems, dyspnea, and implant problems-and gait function after hip surgery [47]. Koutalos and colleagues [45] demonstrated that functional decline-the Barthel Index (BI)-was identified at a one-year follow-up, particularly worsening in the physical domain in older patients who underwent surgical treatment for hip fracture. Also, the study of Fitzgerald and colleagues [48] highlighted that the time to surgery (36 h or less after injuries) and prior injury functional status were significant factors predicting independent mobility one week post-surgery.…”

The Definition of the Term “Orthogeriatric Infection” for Periprosthetic Joint Infections

“…Also, lower Barthel indices were determined in patients with fracture-related infection of the hip compared with a matched control group without infection. 28 A recent study conducted in Spain collected the Barthel scores in 2 nursing homes before and after an infection with Covid-19. In their cohort (mean age 85.9 ± 6.42, 34 male/34 female) the post Covid Barthel total score was 52.30 ± 27.22 (44.56-60.04), which was higher than in the cohort analyzed here (40.2 ± 26.8), emphasizing the burden of PJI.…”