Surgical delay as a risk factor for wound infection after a hip fracture

ABSTRACTPurposeAnalysis of significant risk factors for mortality and for medical and orthopaedic complications.Patients and methodsObservational study of a prospective consecutive cohort of 697 patients diagnosed of hip fracture from December 2012 to December 2014. Average age was 85 ± 9 years and 520 were female (75%). Intracapsular fractures (308, 44%) were treated non-operatively, (19 patients), with cannulated screws (58) or with hip arthroplasty (228 bipolar, 3 total hip atrhoplasty). Extracapsular fractures (389, 56%) were reduced and fixed with 375 trochanteric nails and 14 sliding-hip-screw-plates. Patients were controlled clinically and radiographically in outpatient clinic after 1, 3, 6 and 12 months. Bivariate analysis (Pearson, Mann-Whitney, Wilcoxon) was applied to study statistically significant relations, and Odds Ratio were calculated.ResultsSurgical delay reached 2.1 ± 2.2 days, 1.7 ± 1.9 in medically stable patients. Main reason for delay was anticoagulant/anti-platelet therapy. Immediate weight-bearing was begun for 72% of patients. Average time in-hospital was 12 ± 8 days and 63% returned to previous environment. Lost-to-follow-up reached 4% after 1 month and 8% after 6 months. After 1 year, 6% of previously-walking patients were unable to walk. Mortality reached 4% while in-hospital and 14% after 1 year, with older age as only significant risk factor (p = 0.004), OR = 1.9. Wound infection developed in 2.3% of the series, and surgical delay longer than 24 hours was a significant risk factor (p = 0.023), with an OR = 3.48 (1.1-10.8). Fixation failed in 7.9% of cannulated screws and 1.9% of trochanteric nails (1.1% cut-out, 0.8% nail fracture), while 2.7% of arthroplasty patients suffered a prosthesis dislocation and 1.3% a periprosthetic fracture. Pyelonephritis appeared in 6.7%, pneumonia in 6.3% and cardiac failure in 2.2% of patients; significant risk factors were previous comorbidity for pneumonia (p = 0.007) (OR = 2.7) and cardiac failure (p = 0.007) (OR = 9.7), as well as older age (p = 0.006) (OR = 2.2) for pneumonia.ConclusionsSurgical delay longer than 24 hours has been an important risk factor for wound infection, a finding not previously described in literature. Older age is a significant risk factor for mortality and pneumonia, and previous comorbidity for cardiac failure and pneumonia.