Impact of deep infection after hip fracture surgery on function and mortality
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.
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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)
- et al.
Computer registration of infections used to measure the effect of prophylactic antibiotics on postoperative infections following osteosynthesis in hip fractures
J Hosp Infect
(1994) - et al.
Antibiotic prophylaxis in proximal femoral fracture
Injury
(1990) - et al.
Monitoring infective complications following hip fracture
J Hosp Infect
(1998) - et al.
Re-operations following Austin Moore hemiarthroplasty: a district hospital experience
Injury
(2001) - et al.
Audit of deep wound infection following hip fracture surgery
J R Coll Surg Edinb
(2000) The social consequences of surgical complications for patients with proximal femoral fractures
Age Ageing
(1993)- et al.
Serum albumin and deep infection in femoral neck fractures. A study of 437 cases followed for one year
Int Orthop
(1998) - et al.
Antibiotic prophylaxis in operations on trochanteric femoral fractures
J Bone Joint Surg Am
(1978) - et al.
General considerations for the analysis of case–control studies
(1980) - et al.
Plastic adhesive drapes and wound infection after hip fracture surgery
Aust N Z J Surg
(1993)
Why use drains?
J Bone Joint Surg Br
The treatment of fractures of the femoral neck
Clin Orthop
Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports
J Bone Joint Surg Am
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