Surgical site infection after hip fracture surgery

Masters, James; Metcalfe, David; Ha, Joon Soo; Judge, Andrew; Costa, Matthew L.

doi:10.1302/2046-3758.99.bjr-2020-0023.r1

Cited by 24 publications

(11 citation statements)

References 35 publications

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“…Previous studies on NIs in elderly patients who receive surgical treatment of hip fractures have mainly focused on surgical site infections (SSI) [11]. Factors such as age [10], comorbidities [12,13], surgical methods [14], season [15], and delayed surgery [12,16,17] have been found to be related to the occurrence of SSIs.…”

Section: Introductionmentioning

confidence: 99%

The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity

Deng

Zheng

Cheng

et al. 2021

International Orthopaedics (SICOT)

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Purpose This is a retrospective case–control study to ascertain the factors influencing nosocomial infection (NI) in elderly patients with hip fractures. Methods A total of 80,174 patients (≥ 60 years) who suffered hip fractures between 2006 and 2017 were identified through a national inquiry of 94 hospitals. The patients were divided into an NI group and control group according to the occurrence or lack of occurrence of NI within 48 hours after surgery, respectively. Age, gender, hip fracture pattern, whether to operate, surgical treatments, and comorbidities were recorded as variables. Results A total of 9806 elderly hip fracture patients (60 years) were included, 1977 of whom were patients diagnosed with NI. The control group consisted of randomly drawn cases from the 9806 patients from different hospitals with a rate of one NI patient: four patients without NI. Patient gender, age, and in particular the number of comorbidities were associated with occurrence of NI. Using regression models to predict infection outcomes based on the number of comorbidities had an area under the curve (AUC) of 0.714, while using the Charlson comorbidity index (CCI) yielded a smaller value of 0.694. The most common comorbidities of this elderly cohort were chronic respiratory disease, hypertension, diabetes mellitus, cerebrovascular disease, and coronary heart disease. Conclusions Older age, male gender, and greater number of comorbidities were found to be associated with the occurrence of NI. In particular, the number of comorbidities was the most accurate predictor of NI occurrence, and when used to build a regression model, it had greater predictive capability than CCI to predict NI in elderly hip fracture patients. Additionally, the common diseases of the elderly should be primarily considered when investigating the relationship between comorbidities and NI in older patients.

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Section: Introductionmentioning

confidence: 99%

The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity

Deng

Zheng

Cheng

et al. 2021

International Orthopaedics (SICOT)

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“…A recent study from the UK by Masters et al ( 6 ) found an increased number of reoperations due to SSI. The study included SSI with and without operation and was based on 20 studies from 18 UK institutions with vast variations in SSI definition.…”

Section: Discussionmentioning

confidence: 96%

“…Studies have indicated an increase in SSI in primary arthroplasties over a 10-year period ( 5 ), but to our knowledge data on time-trend in reoperation due to SSI after hip fracture is lacking. A recent review from 2020 ( 6 ) found an overall incidence of 2.1% reoperation due to SSI (varying from 1% to 12%). The review included hip fracture patients from 20 studies of which most were retrospective, single-center studies, and only of UK origin, with considerable inter-study differences, including SSI definitions.…”

mentioning

confidence: 99%

Risk of reoperation due to surgical site infection in 74,771 hip fracture patients: a Danish nationwide cohort study

Kristensen

Lange

Frøslev

et al. 2022

ActaO

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Background and purpose: Surgical site infection (SSI) after hip fracture surgery is a feared condition. We examined the trend in incidence of reoperation due to SSI up to 1 year following hip fracture surgery from 2005 to 2016 and risk factors of SSI by age, sex, comorbidity, type of fracture, and surgery.Patients and methods: We conducted a population-based, nationwide cohort study using data from the Danish Multidisciplinary Hip Fracture Register (DMHFR). We included 74,771 patients aged 65 and up who underwent surgery from 2005 to 2016 for all types of hip fracture. We calculated net risk of reoperation using Kaplan–Meier method, and, with Cox regression, adjusted hazard ratios (HRs) with a 95% confidence interval (CI) for reoperation due to SSI.Results: Overall, the 1-year net risk of reoperation due to SSI was 2.7%. The HR was lower for patients undergoing total/hemiarthroplasty surgery versus internal fixation (HR = 0.6; 95% CI 0.5–0.6) and for patients with per-/subtrochanteric fracture versus femoral neck fracture (HR = 0.7; CI 0.6–0.8). The risk of reoperation due to SSI decreased over time; HR was 0.6 (CI 0.5–0.7) for 2015–2016 compared with 2005–2006. Risk of reoperation decreased with increasing age; the HR was 0.6 (CI 0.6–0.7) in the more than 85-year-olds compared with 65–74-year-old patients.Interpretation: The net risk of reoperations due to SSI in our study was higher than previously assumed. We identified several risk factors for increased risk of reoperation due to SSI, most noticeably treatment with internal fixation vs. arthroplasty, as well as younger age and femoral neck fracture diagnosis.

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“…One major complication of arthroplasty is the development of a periprosthetic joint infection (PJI), which occurs in up to 3% of the performed (partial) arthroplasties [ 7 , 8 ]. Besides a high psychological burden for patients and their families, PJI often need a two-stage revision procedure and therefore demonstrate immense socioeconomic costs for the healthcare systems [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Prophylactic Effect of Single vs. Dual Antibiotic-Loaded Bone Cement against Periprosthetic Joint Infection Following Hip Arthroplasty for Femoral Neck Fracture: An Analysis of the German Arthroplasty Registry

et al. 2023

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Background: Antibiotic-loaded bone cement in arthroplasties is currently experiencing increased usage. Therefore, single and double antibiotic-loaded bone cements are commercially available and used in orthopedic surgery. The aim of this investigation was to compare the clinical use of single compared to dual antibiotic-loaded bone cement for implant fixation after femoral neck fracture. Further infection rates were to be compared in (partial) arthroplasty for the treatment of femoral neck fracture for both treatment options. Methods: On the basis of the German Arthroplasty Registry (EPRD), all cases of femoral neck fracture treated with hemiarthroplasty (HA), or total hip arthroplasty (THA) with single and dual antibiotic-loaded bone cement, were included into the data analysis. The infection risk was compared using Kaplan-Meier estimates. Results: In total, 26,845 cases (HA 76.3%—THA: 23.7%) with femoral neck fracture were included. Within recent years, an increasing usage of dual antibiotic-loaded cement in Germany, with a current proportion of 7.30% in arthroplasty procedures for femoral neck fracture treatment, has been observed. In patients treated with HA, the proportion of dual antibiotic-loaded cement was 7.86%, while in those treated with THA, 5.46% of all prostheses were fixated with a two antibiotic component cement. For all arthroplasty procedures using single antibiotic-loaded bone cement after six months 1.8%, after one year 1.9%, and after five years 2.3%, of the cases failed due to periprosthetic joint infection (PJI), while in the same time period, in cases with dual antibiotic-loaded bone cement 1.5%, 1.5% and 1.5% suffered from infection (p = 0.34). A infection rate of 1.1% after HA with dual antibiotic-loaded bone cement was reported, compared to a 2.1% infection rate whilst using single antibiotic-loaded bone cement after five years (p = 0.098). The number required for treatment when using HA was 91. Conclusions: The use of dual antibiotic-loaded bone cement is increasingly used in arthroplasty procedures after femoral neck fractures. It demonstrates a reduction of PJI after HA and seems, therefore, to be a useful method for the prevention of infection, especially in patients with increased risk factors for PJI.

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Surgical site infection after hip fracture surgery

Cited by 24 publications

References 35 publications

The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity

The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity

Risk of reoperation due to surgical site infection in 74,771 hip fracture patients: a Danish nationwide cohort study

The Prophylactic Effect of Single vs. Dual Antibiotic-Loaded Bone Cement against Periprosthetic Joint Infection Following Hip Arthroplasty for Femoral Neck Fracture: An Analysis of the German Arthroplasty Registry

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