Liu Xiaopo, Dong Zhijie, Li Jun, Feng Yunbo, Cao Guolong, Song Xin, Yang Jie
Third Department of Orthopaedics, Tangshan Gongren Hospital, Tangshan, Hebei, 063000, People's Republic of China.
Department of Orthopaedic Surgery, Hebei General Hospital, Shijiazhuang, Hebei, 063000, People's Republic of China.
J Orthop Surg Res. 2019 Nov 21;14(1):382. doi: 10.1186/s13018-019-1449-6.
Geriatric hip fracture is a common type of osteoporotic fracture with high mortality and disability; surgical site infection (SSI) can be a devastating complication of this injury. By far, only a few studies identified easily remediable factors to reduce infection rates following hip fracture and less researches have focused on geriatric patients. The objective of this study was to identify potentially modifiable factors associated with SSI following geriatric hip fracture surgery.
This retrospective, multicenter study involves three level I hospitals. A total of 1240 patients (60 years or older) underwent hip surgery with complete data were recruited between January 2016 and June 2018. Demographics information, medications and additional comorbidities, operation-related variables, and laboratory indexes were extracted and analyzed. Receiver operating characteristic (ROC) analysis was performed to detect the optimum cut-off value for quantitative data. Univariate and multivariate logistic analysis model were performed respectively to identify the independent predictors.
Ninety-four (7.58%) patients developed SSI in this study, and 76 (6.13%) had superficial infection, while 18 (1.45%) were diagnosed with deep infection. Results of univariate and multivariate analysis showed age > 79 years (OR, 2.60; p < 0.001), BMI > 26.6 kg/m (OR, 2.97; p < 0.001), operating time > 107 min (OR, 2.18; p = 0.001), and ALB < 41.6 g/L (OR, 2.01; p = 0.005) were associated with an increased incidence of SSI; drainage use (OR, 0.57; p = 0.007) could reduce the incidence of wound infection for patients after geriatric hip fracture.
Accurate modifiable variables, operating time > 107 min, serum albumin < 41.6 g/L, BMI > 26.6 kg/m, and age > 79 years could be applied to distinguish geriatric patients with high-risk of postoperative surgical site infection.
老年髋部骨折是骨质疏松性骨折的常见类型，具有较高的死亡率和致残率；手术部位感染（SSI）可能是这种损伤的灾难性并发症。到目前为止，只有少数研究确定了易于纠正的因素以降低髋部骨折后的感染率，而针对老年患者的研究较少。本研究的目的是确定与老年髋部骨折手术后SSI相关的潜在可改变因素。
这项回顾性多中心研究涉及三家一级医院。2016年1月至2018年6月期间，共招募了1240例（60岁及以上）接受髋部手术且数据完整的患者。提取并分析人口统计学信息、用药情况、其他合并症、手术相关变量和实验室指标。进行受试者操作特征（ROC）分析以检测定量数据的最佳截断值。分别进行单因素和多因素逻辑分析模型以确定独立预测因素。
本研究中有94例（7.58%）患者发生了SSI，其中76例（6.13%）为浅表感染，18例（1.45%）被诊断为深部感染。单因素和多因素分析结果显示，年龄>79岁（OR，2.60；p<0.001）、BMI>26.6kg/m（OR，2.97；p<0.001）、手术时间>107分钟（OR，2.18；p=0.001）和白蛋白<41.6g/L（OR，2.01；p=0.005）与SSI发生率增加相关；使用引流（OR，0.57；p=0.007）可降低老年髋部骨折患者伤口感染的发生率。
准确的可改变变量，即手术时间>107分钟、血清白蛋白<41.6g/L、BMI>26.6kg/m和年龄>79岁，可用于区分术后手术部位感染高危的老年患者。
