Surgical site infection after trochanteric and subtrochanteric fractures: a single centre retrospective analysis

Abstract

Surgical site infection (SSI) following osteosynthesis of trochanteric or subtrochanteric fractures is a rare but serious complication with incidence rate ranging from 1 to 3%. SSIs are associated with higher mortality and increased length of hospital stay resulting in higher healthcare costs and loss of life quality. In this retrospective analysis all patients with SSI following osteosynthesis of trochanteric or subtrochanteric fractures at the Department of Trauma Surgery were identified. We included all surgical procedures performed from 1992 to 2018, using data from electronic health records and SSI-Trauma-Registry. The aim was to describe epidemiological data, as well as to identify parameters correlating with the occurrence of SSI and mortality. Of 2753 patients, 53 (1.9%) developed SSI. Longer operative time was demonstrated among patients with SSI (P = 0.008). Mortality during the first postoperative year was significantly higher in the SSI group (32.1% vs. 19.1%; P = 0.018), with detection of methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA; HR 4.13, CI 95% 1.24–13.80; P = 0.021) or Enterococcus spp. (HR 5.58, CI 95% 1.67–18.65; P = 0.005) being independent risk factors. Male sex (HR 2.25, 95% CI 1.86–2.73; P < 0.001) and higher mean age (HR 1.05, 95% CI 1.04–1.06; P < 0.001) were found to be predictors for 1-year mortality in non-infected patients. SSI rate was low with 1.9% and longer duration of surgery was associated with infection. Patients with SSI had a higher 1-year mortality, with detection of MSSA, MRSA and enterococci significantly increasing the risk of dying. Male sex and higher age were risk factors for one-year mortality in patients without SSI.

Risk Factors for Therapeutic Failure and One-Year Mortality in Patients with Intramedullary Nail-Associated Infection after Trochanteric and Subtrochanteric Hip Fracture Repair

“…Our study describes risk factors for therapeutic failure and one-year mortality in a cohort of patients diagnosed with trochanteric and subtrochanteric IM nail infection at a major Spanish academic hospital during a ten-year period. During the study period, the overall incidence of trochanteric and subtrochanteric IM nail infection was 0.87%, slightly lower than in other series [7][8][9]. Patients were mostly aged over 75 years and presented high levels of comorbidity, consistent with other studies [2,[21][22][23].…”

“…A previous, single-center retrospective study set in Austria found an association between gram-positive microorganisms such as Staphylococcus aureus (including methicillin-resistant strains) and Enterococcus spp. and higher rates of mortality in patients with infection after trochanteric or subtrochanteric fractures treated with osteosynthesis [9]. However, this association was not observed in our series.…”

“…To the best of our knowledge, this is the largest cohort to feature patients with trochanteric and subtrochanteric IM nail-associated infection. Existing studies reporting prevalence and risk factors for infection after IM nailing of trochanteric fractures include patients with both superficial and deep surgical site infection [7,9], whereas our study focuses exclusively on deep surgical site infection. Despite its relatively small sample size, the homogenous nature of our cohort allowed us to perform an analysis of risk factors for therapeutic failure and one-year mortality, which has not been reported previously in the literature.…”

“…The potential complications of intramedullary nailing include mechanical complications such as cutout, early implant fracture, and delayed union [3,4] and medical complications such as bleeding, pulmonary embolism, and implant-associated infection [5,6]. Deep surgical site infection after intramedullary nailing of these fractures is uncommon, with an incidence of around 1-1.5% [7][8][9]. However, these infections lead to worse patient outcomes and increased healthcare expenditure due to additional surgical interventions, extended hospital stays, and long periods of antibiotic treatment [10,11].…”