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. 2020 Sep 3;9(9):554-562.
doi: 10.1302/2046-3758.99.BJR-2020-0023.R1. eCollection 2020 Sep.

Surgical site infection after hip fracture surgery: a systematic review and meta-analysis of studies published in the UK

James Masters  1 , David Metcalfe  1 , Joon Soo Ha  2 , Andrew Judge  1   3 , Matthew L Costa  4
Affiliations

Surgical site infection after hip fracture surgery: a systematic review and meta-analysis of studies published in the UK

James Masters et al. Bone Joint Res. .

Abstract

Aims: This study explores the reported rate of surgical site infection (SSI) after hip fracture surgery in published studies concerning patients treated in the UK.

Methods: Studies were included if they reported on SSI after any type of surgical treatment for hip fracture. Each study required a minimum of 30 days follow-up and 100 patients. Meta-analysis was undertaken using a random effects model. Heterogeneity was expressed using the I2 statistic. Risk of bias was assessed using a modified Newcastle-Ottawa Scale (NOS) system.

Results: There were 20 studies reporting data from 88,615 patients. Most were retrospective cohort studies from single centres. The pooled incidence was 2.1% (95% confidence interval (CI) 1.54% to 2.62%) across 'all types' of hip fracture surgery. When analyzed by operation type, the SSI incidences were: hemiarthroplasty 2.87% (95% CI 1.99% to 3.75%) and sliding hip screw 1.35% (95% CI 0.78% to 1.93%). There was considerable variation in definition of infection used, as well as considerable risk of bias, particularly as few studies actively screened participants for SSI.

Conclusion: Synthesis of published estimates of infection yield a rate higher than that seen in national surveillance procedures. Biases noted in all studies would trend towards an underestimate, largely due to inadequate follow-up.

Keywords: Epidemiology; Hip fracture; Surgical site infection.

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Figures

Fig. 1
Fig. 1
Outline of the process of study selection.
Fig. 2
Fig. 2
Synthesis of studies reporting surgical site infection (SSI) for hip fracture of all surgical types. Meta-analysis of reported rates of SSI in ‘all hip fracture surgery’ using random effects model. Heterogeneity is expressed using the I2 statistic. CI, confidence interval; ES-SSI, estimate from each study.
Fig. 3
Fig. 3
Summary of studies reporting hemiarthroplasty. Meta-analysis of reported rates of surgical site infection (SSI) in hemiarthroplasty using random effects model. Heterogeneity is expressed using the I2 statistic. CI, confidence interval; ES-SSI, estimate from each study.
Fig. 4
Fig. 4
Summary of studies reporting surgical site infection (SSI) after sliding hip screw (SHS). Meta-analysis of reported rates of SSI in SHS using random effects model. Heterogeneity is expressed using the I2 statistic. CI, confidence interval; ES-SSI, estimate from each study.
Fig. 5
Fig. 5
Summary of studies clustered by definition of surgical site infection (SSI). Meta-analysis of reported rates of SSI according to study definition using random effects model. Heterogeneity is expressed using the I2 statistic. Formal definitions encompass either a referenced study on SSI or a formal definition used by a public health body, e.g. Centers for Disease Control and Prevention. CI, confidence interval; ES-SSI, estimate from each cluster.
Fig. 6
Fig. 6
Percentage rate of surgical site infection (SSI) for studies included in systematic review by study population. Summary data plotting reported rate of SSI against the study population size. The pooled estimate for ‘all hip fractures’ is also plotted with 95% confidence intervals. Studies not included in the pooled estimate are circled for reference.
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References

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