Impact of deep infection after hip fracture surgery on function and mortality

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Summary

Our aim was to evaluate the impact of deep wound infection after hip fracture surgery on functional outcome and mortality. Two thousand, two hundred and seventy-six consecutive surgically treated patients with non-pathological fractures, aged over 50 years (mean age 78.3 years), were followed up prospectively. The 29 patients who had deep infection (rate 1.3%) and who received revision surgery were compared with controls without infection, matched for age, sex, residential status at fracture, fracture type, treatment method and walking ability. When the functionality of hip fracture patients was evaluated four months after the primary operation, the patients with deep wound infection had impaired walking ability (P=0.039) and required walking aids, including wheelchairs, more often than the control patients (48% vs 20.8%, P=0.022). At four months, the mean duration of hospitalization at the primary hospital was significantly longer for the cases than the controls (P<0.001). Diabetes was more common in the patients with deep infection (P=0.038). Staphylococcus aureus was the most commonly isolated micro-organism, and it was associated with higher one-year mortality (57%) than the other bacteria (14.3%, P=0.014); the overall mortality of the infected patients and controls was 34.5% and 24.1% at one year, respectively (P=0.508). In conclusion, deep infection after a hip fracture operation impairs short-term functional outcome and slightly increases mortality, with an excess mortality rate of 10.4%.

Introduction

Deep infection after hip fracture surgery is a rare but severe complication.1 Deep wound infection is associated with high fatality and, in the survivors, a prolonged need for inpatient treatment, a marked decline in mobility and a great increase in social dependency. Deep infections also result in additional costs for the hospital and for society.2, 3

However, the impact of deep wound infection after hip fracture on the outcome is not well documented. Only one study3 could be found in the literature focusing on the consequences of deep infection for patients compared with controls without infection. Our aim was to study the effect of deep wound infection after hip fracture surgery on short-term function and mortality by comparing infected patients with well-matched controls without infection.

Section snippets

Patients and methods

All patients admitted to the University Hospital of Oulu between 1989 and 1999 with non-pathological hip fractures, aged over 50 years (mean age 78.3 years), and who were treated by operative intervention were eligible for inclusion in this study. There were 1314 femoral neck fractures, 55 basocervical fractures, 371 trochanteric two-fragment fractures, 460 trochanteric multifragment fractures and 99 subtrochanteric fractures.

Four hundred and thirty-seven patients were treated with two or three

Results

Twenty-nine (mean age 79.7, range 56–92 years) of the 2276 surgical patients developed deep infection (rate 1.3%) and had revision surgery. Eight patients were men (mean age 73.9, range 56–89 years, infection rate 1.4%) and 21 patients were women (mean age 82.0, range 60–92 years, infection rate 1.2%). The infection appeared after the primary operation in 25 cases and after a re-operation in four cases. The mean delay of the re-operation for infection was 84 (range 5–300) days. Bacteriological

Discussion

The overall deep infection rate among hip fracture patients was quite low (1.3%), being of the same order as in several recent studies.1, 8, 9, 10, 11, 12 Higher percentages have been reported in older studies, ranging between 2.2% and 16.9%.5, 6, 13 The reduction in incidence has been attributed mainly to advances in theatre design and practice, surgical techniques, antibiotic prophylaxis and wound care.1, 8, 9, 10, 11, 12 However, it is difficult to compare infection rates between different

Acknowledgements

We thank Mrs Eila Haapakoski for her work with the data collection.

References (26)

  • J.P. Cobb

    Why use drains?

    J Bone Joint Surg Br

    (1990)
  • C. Gerber et al.

    The treatment of fractures of the femoral neck

    Clin Orthop

    (1993)
  • G.L. Lu-Yao et al.

    Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports

    J Bone Joint Surg Am

    (1994)
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