Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture

Zajonz, Dirk; Brand, Alexander; Lycke, Christian; Özkurtul, Orkun; Theopold, Jan; Spiegl, Ulrich; Röth, Andreas; Josten, Christoph; Fakler, Johannes K. M.

doi:10.1007/s00068-018-0909-8

Cited by 35 publications

(31 citation statements)

References 31 publications

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“…Data on patients' comorbidities was restricted to the ASA score and cognitive impairment, while no information was available on some known risk factors for SSI, such as diabetes mellitus (Tsang and Gaston 2013), obesity (Zajonz et al 2019), or smoking (Durand et al 2013). Obesity, in par-ticular, represents an unobserved confounder in the association between duration of surgery and SSI.…”

Section: Risk Factors For Early and Delayed Deep Surgical Site Infectionmentioning

confidence: 99%

“…Considering the serious consequences of SSI for hip fracture patients it is important to optimize modifiable risk factors. However, reported risk factors differ, ranging from operative delay to the lead surgeon's experience, duration of surgery, choice of implant, and patient factors such as obesity (Harrison et al 2012, Cordero et al 2016, de Jong et al 2017, Zajonz et al 2019.…”

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confidence: 99%

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Surgical site infection after hip fracture – mortality and risk factors: an observational cohort study of 1,709 patients

et al. 2020

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Background and purpose — Surgical site infection (SSI) is a devastating complication of hip fracture surgery. We studied the contribution of early deep SSI to mortality after hip fracture surgery and the risk factors for deep SSI with emphasis on the duration of surgery. Patients and methods — 1,709 patients (884 hemiarthroplasties, 825 sliding hip screws), operated from 2012 to 2015 at a single center were included. Data were obtained from the Norwegian Hip Fracture Register, the electronic hospital records, the Norwegian Surveillance System for Antibiotic Use and Hospital-Acquired Infections, and the Central Population Register. Results — The rate of early (≤ 30 days) deep SSI was 2.2% (38/1,709). Additionally, for hemiarthroplasties 7 delayed (> 30 days, ≤ 1 year) deep SSIs were reported. In patients with early deep SSI 90-day mortality tripled (42% vs. 14%, p < 0.001) and 1-year mortality doubled (55% vs. 24%, p < 0.001). In multivariable analysis, early deep SSI was an independent risk factor for mortality (RR 2.4 for 90-day mortality, 1.8 for 1-year mortality, p < 0.001). In univariable analysis, significant risk factors for early and delayed deep SSI were cognitive impairment, an intraoperative complication, and increasing duration of surgery. However, in the multivariable analysis, duration of surgery was no longer a significant risk factor. Interpretation — Early deep SSI is an independent risk factor for 90-day and 1-year mortality after hip fracture surgery. After controlling for observed confounding, the association between duration of surgery and early and delayed deep SSI was not statistically significant.

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Section: Risk Factors For Early and Delayed Deep Surgical Site Infectionmentioning

confidence: 99%

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confidence: 99%

Surgical site infection after hip fracture – mortality and risk factors: an observational cohort study of 1,709 patients

et al. 2020

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“…Despite the enormous progress in surgical treatment for reducing the risk of infections, periprosthetic joint infections (PJI) remain a major challenge and risk for the affected patients, the health system, and attending personnel [1][2][3][4]. Considering the grave effects of PJI on patients and the society, the optimization of patient-related risk factors is vital [4]. The effects of nutritional status and protein balance are considered to be significant prognostic factors for the development of PJI [5,6].…”

Section: Introductionmentioning

confidence: 99%

Significance of nutritional status in the development of periprosthetic infections

et al. 2020

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Background Malnutrition caused by protein and vitamin deficiencies is a significant negative prognostic factor in surgical wound healing disorders and infections. Particularly in elective surgery, preoperative compensation of deficiencies is advisable to avoid negative postoperative consequences. This study examined the nutritional and protein balance of patients with periprosthetic hip and knee joint infections. Material and methods Patients with periprosthetic hip or knee joint infections constituted the study group (SG). Control group I (CG I) included patients with primary implants and CG II included patients who required revision surgery because of aseptic loosening. Relevant nutritional and protein parameters were determined via analysis of peripheral venous blood samples. In addition, a questionnaire was used to evaluate the nutritional and eating patterns of all patients. The nutritional risk screening (NRS) 2002 score and body mass index (BMI) were also calculated for all participants. Results Differences were found in the albumin level (SG: 36.23 ± 7.34, CG I: 44.37 ± 3.32, p < 0.001, CG II: 44.06 ± 4.24, p < 0.001) and total protein in serum (SG: 65.42 ± 8.66, CG I: 70.80 ± 5.33, p = 0.004, CG II: 71.22 ± 5.21, p = 0.004). The number of patients with lowered albumin levels (SG 19/61, CG I 1/78, CG II 2/55) and total protein in serum (SG: 12/61, CG I 5/78, CG II 2/55) also showed considerable variation. The number of patients with a NRS 2002 score ≥3 differed significantly between SG and both CGs (SG: 5/61, CG I 1/78, CG II 0/55); however, these differences could not be confirmed using BMI. Conclusion As expected, lowered albumin and total protein levels were observed in PJI due to the acute phase reaction. The NRS can be performed to exclude nutritional deficiency, which cannot be excluded based on BMI. In cases of periprosthetic joint infection it is reasonable to compensate the nutritional deficiency with dietary supplements.

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“…14 Despite the presence of considerable data regarding in ammatory mediation, little study to date has examined the propensity for preoperative in ammatory markers to relate to early postoperative complications, with most work instead being presently directed towards their use as snapshot indicators rather than as re ectors of biological balance throughout the perioperative period. [15][16][17][18][19] This clinical study was performed to test the hypothesis that elevated preoperative in ammatory markers, particularly CRP, in patients without overt sepsis, may signify a complicated early postoperative course following elective colorectal resection. Such markers may thereby act as early risk strati cation tools for patients potentially facing clinical deviation from expected trajectories.…”

Section: Introductionmentioning

confidence: 99%

Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

Alsaif

Rogers

Pua

et al. 2021

Preprint

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Background: Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim: The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods: This retrospective study catalogues 218 patients undergoing elective, potentially-curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results: Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6 and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC=0.871), and values above 17.5 mg/L predicted severe complications (AUC=0.934). Conclusions: Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

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Risk factors for early infection following hemiarthroplasty in elderly patients with a femoral neck fracture

Abstract: Preoperative serum CRP levels, higher BMI and prolonged surgery time are independent predictors of early PJI. Excluding PJI secondary to major revision surgery revealed chronic glucocorticoid use as a risk factor apart from preoperative CRP levels.

Cited by 35 publications

References 31 publications

Surgical site infection after hip fracture – mortality and risk factors: an observational cohort study of 1,709 patients

Surgical site infection after hip fracture – mortality and risk factors: an observational cohort study of 1,709 patients

Significance of nutritional status in the development of periprosthetic infections

Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

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