University of Nevada, Reno School of Medicine, Reno, NV, USA.
Stanford University School of Medicine, Stanford, CA, USA.
Injury. 2023 Aug;54(8):110833. doi: 10.1016/j.injury.2023.05.064. Epub 2023 May 20.
There is a paucity of research in the rates for sepsis and septic shock in the hip fracture population specifically, despite marked clinical and prognostic differences between these conditions. The purpose of this study was to determine the incidence, risk factors, and mortality rates for sepsis and septic shock as well as evaluate potential infectious causes in the surgical hip fracture population.
The ACS-NSQIP (2015-2019) was queried for patients who underwent hip fracture surgery. A backward elimination multivariate regression model was used to identify risk factors for sepsis and septic shock. Multivariate regression that controlled for preoperative variables and comorbidities was used to calculate the odds of 30-day mortality.
Of 86,438 patients included, 871 (1.0%) developed sepsis and 490 (0.6%) developed septic shock. Risk factors for both postoperative sepsis and septic shock were male gender, DM, COPD, dependent functional status, ASA class ≥3, anemia, and hypoalbuminemia. Unique risk factors for septic shock were CHF and ventilator dependence. The 30-day mortality rate was 4.8% in aseptic patients, 16.2% in patients with sepsis, and 40.8% in patients who developed septic shock (p < 0.001). Patients with sepsis (OR 2.87 [95% CI 2.37-3.48], p < 0.001) and septic shock (OR 11.27 [95% CI 9.26-13.72], p < 0.001) had increased odds of 30-day mortality compared to patients without postoperative septicemia. Infections that preceded a diagnosis of sepsis or septic shock included urinary tract infections (24.7%, 16.5%), pneumonia (17.6%, 30.8%), and surgical site infections (8.5%, 4.1%).
The incidence of sepsis and septic shock after hip fracture surgery was 1.0% and 0.6%, respectively. The 30-day mortality rate was 16.2% in patients with sepsis and 40.8% in patients with septic shock. Potentially modifiable risk factors for both sepsis and septic shock were anemia and hypoalbuminemia. Urinary tract infections, pneumonia, and surgical site infections preceded the majority of cases of sepsis and septic shock. Prevention, early identification, and successful treatment of sepsis and septic shock are paramount to lowering mortality after hip fracture surgery.
尽管髋关节骨折患者的败血症和感染性休克在临床表现和预后方面存在显著差异，但针对此类患者的败血症和感染性休克发生率、风险因素和死亡率的研究相对较少。本研究旨在确定髋关节骨折患者中败血症和感染性休克的发生率、风险因素和死亡率，并评估手术相关的潜在感染原因。
通过 ACS-NSQIP（2015-2019 年）数据库，检索接受髋关节骨折手术的患者。采用向后逐步消除的多变量回归模型来确定败血症和感染性休克的风险因素。通过多变量回归分析控制术前变量和合并症，计算 30 天死亡率的比值比。
在纳入的 86438 例患者中，871 例（1.0%）发生败血症，490 例（0.6%）发生感染性休克。术后败血症和感染性休克的危险因素均为男性、糖尿病、慢性阻塞性肺病、依赖功能状态、ASA 分级≥3、贫血和低白蛋白血症。感染性休克的独特危险因素为充血性心力衰竭和呼吸机依赖。无菌性患者的 30 天死亡率为 4.8%，败血症患者为 16.2%，感染性休克患者为 40.8%（p<0.001）。与术后无败血症患者相比，发生败血症（比值比 2.87[95%置信区间 2.37-3.48]，p<0.001）和感染性休克（比值比 11.27[95%置信区间 9.26-13.72]，p<0.001）的患者 30 天死亡率更高。在败血症或感染性休克发生之前，导致感染的主要原因包括尿路感染（24.7%，16.5%）、肺炎（17.6%，30.8%）和手术部位感染（8.5%，4.1%）。
髋关节骨折手术后败血症和感染性休克的发生率分别为 1.0%和 0.6%。败血症患者的 30 天死亡率为 16.2%，感染性休克患者的 30 天死亡率为 40.8%。贫血和低白蛋白血症是败血症和感染性休克的潜在可调节危险因素。尿路感染、肺炎和手术部位感染是导致大多数败血症和感染性休克的主要原因。预防、早期识别和成功治疗败血症和感染性休克对于降低髋关节骨折手术后的死亡率至关重要。
