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Incidence and risk factors associated with postoperative surgical site infection in younger adults with hip fractures: a case–control study

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Abstract

Purpose

Hip fracture is associated with high morbidity and mortality. The most common complication after hip fracture is surgical site infection (SSI). The goal was to investigate risks associated with SSI in young adults who underwent surgery for hip fractures.

Methods

We conducted a case–control study enrolling 1243 patients from Jan 2015 to Dec 2019. This study investigated the multifaceted factors including demographics, lifestyles, comorbidities, surgical variables, and laboratory test results. Patients were divided into the case group (developed SSI) and control group (not developed SSI). Univariate analyses and multivariate logistic regression analyses were used to identify the risk factors independently associated with SSI.

Results

A total of 25 patients including 16 (1.8%) in femoral neck fracture and nine (2.5%) in intertrochanteric fracture developed SSI post-operatively, with an accumulated incidence rate of 2.0%. Among them, four cases (1.6%) were deep SSI and 21 cases (98.4%) were superficial SSI. In most cases, Staphylococcus aureus caused the infections. Diabetes mellitus (OR 4.05, 95%CI: 1.08–15.23, P = 0.038), cerebrovascular disease (OR 3.71, 95%CI: 1.14–12.03, P = 0.029), heart disease (OR 6.23, 95%CI: 1.81–21.48, P = 0.004), and operative time (OR 1.01, 95%CI: 1.01–1.02, P = 0.002) in femoral neck fractures while ALP (> upper limit) (OR 33.39, 95%CI: 2.21–504.89, P = 0.011) and CK (> upper limit) (OR 40.97, 95%CI: 1.70–989.31, P = 0.022) in intertrochanteric fractures were found to be significantly associated with SSI.

Conclusion

Targeted pre-operative management, depending on the patients’ fracture type and risk factors, should be developed to reduce post-operative SSI rates of younger adults with hip fracture.

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Data availability

The data and code used to support the findings of this study are available from the corresponding author upon request.

Abbreviations

SSI :

Surgical site infection

BMI :

Body mass index

ASA :

American Society of Anesthesiologists

TP :

Serum total protein

ALB :

Albumin

ALT :

Alanine transaminase

AST :

Aspartate aminotransferase

TBIL :

Aspartate total bilirubin

ALP :

Alkaline phosphatase

HCRP :

Hypersensitive C-reactive protein

CK :

Creatine kinase

LDH :

Lactate dehydrogenase

TC :

Total cholesterol

TG :

Triglyceride

GLU :

Glucose

UA :

Uric acid

WBC :

White blood cell

NEU :

Neutrophile granulocyte

LYM :

Lymphocyte

RBC :

Red blood cell

HGB :

Hemoglobin

PLT :

Blood platelet

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Acknowledgements

The authors gratefully acknowledge the work performed by the members of our hospital staff and laboratory.

Funding

The study was financially supported by the National Key R&D Program of China (Grant Number 2019YFC0120600), the Medical Science Research Project of Hebei Province, China (Grant Number 20201008), and the 2019 Hebei Provincial Department of Finance Geriatric Disease Prevention and Control Funds.

Author information

Author notes

  1. Pei Du and Junfei Guo contributed equally to this work.

Authors and Affiliations

  1. Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China

    Pei Du, Yi Cui, Jianmei Li & Zhongjun Feng

  2. Department of Epidemiology and Statistics, Hebei Key Laboratory of Environment and Human Health, School of Public Health, Hebei Medical University, Shijiazhuang, China

    Pei Du

  3. Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China

    Junfei Guo, Yanbin Zhu, Zhiyong Hou & Yingze Zhang

  4. Orthopaedic Institute of Hebei Province, Shijiazhuang, China

    Junfei Guo, Yanbin Zhu, Zhiyong Hou & Yingze Zhang

  5. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China

    Junfei Guo, Yanbin Zhu, Zhiyong Hou & Yingze Zhang

  6. NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, China

    Zhiyong Hou & Yingze Zhang

  7. Chinese Academy of Engineering, Beijing, China

    Yingze Zhang

Authors
  1. Pei Du
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Contributions

Zhiyong Hou and Yingze Zhang as the corresponding authors contribute to all aspects of the research and writing process, and taking final responsibility for the paper. Pei Du, Junfei Guo, and Yanbin Zhu contribute to the analysis and interpretation of data as well as drafting the article. Yi Cui and Jianmei Li contribute to collecting data. Zhongjun Feng contributes to editing. All authors have approved the final article.

Corresponding authors

Correspondence to Zhiyong Hou or Yingze Zhang.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Third Hospital of Hebei Medical University (No. T2018-026–1).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 2–3.

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The authors declare no competing interests.

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Du, P., Guo, J., Zhu, Y. et al. Incidence and risk factors associated with postoperative surgical site infection in younger adults with hip fractures: a case–control study. International Orthopaedics (SICOT) 46, 2953–2962 (2022). https://doi.org/10.1007/s00264-022-05607-7

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  • DOI: https://doi.org/10.1007/s00264-022-05607-7

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