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. 2024 Sep 23:95:570-577.
doi: 10.2340/17453674.2024.41980.

Fracture-related infections after osteosynthesis for hip fracture are associated with higher mortality: A retrospective single-center cohort study

Pendar Khalili  1 , Anders Brüggemann  2 , Staffan Tevell  3 , Per Fischer  4 , Nils P Hailer  2 , Olof Wolf  2
Affiliations

Fracture-related infections after osteosynthesis for hip fracture are associated with higher mortality: A retrospective single-center cohort study

Pendar Khalili et al. Acta Orthop. .

Abstract

Background and purpose: Fracture-related infections (FRIs) after osteosynthesis for hip fractures have not been thoroughly investigated. Our primary aim was to assess the association between FRIs and mortality after osteosynthesis for hip fracture. Secondary aims were to investigate the incidence, microbiology, and general epidemiological aspects of these FRIs.

Methods: This retrospective single-center study included 1,455 patients > 18 years old with non-pathological hip fractures treated with osteosynthesis between 2015 and 2019. Medical records were reviewed and FRIs were diagnosed based on current consensus criteria. The follow-up period was 2 years. Mortality was estimated using Kaplan-Meier survival analysis. Cox regression analyses were performed to investigate the potential association between FRIs, as a time-dependent variable, and increased mortality.

Results: The median age for the entire cohort was 83 (interquartile range 75-89) years and 69% were females. At the 2-year follow-up mark, the crude mortality rate was 33% in the non-FRI group and 69% (11 of 16 patients) in the FRI group. Cox regression analysis assessing mortality risk revealed a hazard ratio of 3.5 (95% confidence interval [CI] 1.9-6.4) when adjusted for confounders. The incidence of FRI was 1.1% (16 of 1,455 patients). Staphylococcus aureus was the most common pathogen. Most FRI patients (94%) required at least 1 revision and 56% underwent ≥ 2 revision.

Conclusion: We found an association between FRIs after hip fracture osteosynthesis and increased mortality, underscoring the critical need for FRI prevention measures in this frail patient group. The incidence and microbiological findings were consistent with previous studies.

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Figures

Figure 1
Figure 1
Flowchart illustrating patient selection.
Figure 2
Figure 2
Illustration of relationships between variables in the study using a directed acyclic graph. The nodes represent death (outcome), FRI (exposure), ASA classification, age, dementia, pathogens, and sex. Arrows indicate directional relationships between variables. The graphical model was utilized to facilitate the selection of variables for adjustment in the Cox regression analysis.
Figure 3
Figure 3
Kaplan–Meier estimates of cumulative incidence of patients developing an FRI (n = 16) within the study cohort (n = 1,455) over a 2-year period after hip fracture osteosynthesis.
Figure 4
Figure 4
Kaplan–Meier estimates of cumulative incidence of mortality for the study cohort (n = 1,455) over a 2-year period after hip fracture osteosynthesis surgery, including 95% confidence intervals, for the non-FRI and FRI groups, with FRI as a time-dependent variable.
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