Orthopedic Department, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Orthopaedic Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University, Ashdod, Israel.
Surg Infect (Larchmt). 2023 Sep;24(7):645-650. doi: 10.1089/sur.2023.118. Epub 2023 Aug 29.
Surgical site infection (SSI) after fragility hip fracture (FHF) surgery is associated with increased morbidity and mortality. We aim to utilize several established nutritional and inflammatory indices to characterize patients at risk. A retrospective cohort study of patients 65 years and older, who underwent surgery following FHFs between January 2012 and June 2020. Those patients who presented with post-operative infection in the year after surgery were compared with patients who did not. The primary outcomes were serum albumin, protein energy malnutrition (PEM), albumin to globulin ratio, prognostic nutritional index (PNI), the systemic immune inflammation index, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and body mass index. A total of 1,546 patients, ages 82.4 ± 7.7, were included; 55 of whom presented with SSI. Demographics and comorbidities were similar. Anticoagulation treatment was more prevalent in the infected group (32.7% vs. 13.9%, p < 0.001) as were intra-capsular fractures (60% vs. 42.9%, respectively; p = 0.012). Of all indices estimated, only the PNI and the PEM were found to differ significantly (44.7 ± 9.6 and 26.1% vs. 49.4 ± 17.3 and 13.6% for the study and control groups respectively; p = 0.002 and 0.027). A logistic regression model was calculated to evaluate the contribution of fracture type and anticoagulation treatment as possible confounders. Both indices were found to be significant for infection after regression odds ratio, 2.25 for PEM; (95% confidence interval [CI], 1.089-4.344) and odds ratio, 0.97 for PNI (95% CI, 0.937-0.996). The PNI and the PEM were found to correlate with infection risk after FHF surgery. As both can be easily calculated from an accessible blood test, we recommend their routine use as a screening tool for tailored management of patients at risk for SSI.
髋部骨折（FHF）术后手术部位感染（SSI）与发病率和死亡率增加有关。我们旨在利用几种已建立的营养和炎症指标来描述有风险的患者。这是一项回顾性队列研究，纳入了 2012 年 1 月至 2020 年 6 月期间接受 FHF 手术后的 65 岁及以上患者。将术后 1 年内出现术后感染的患者与未出现感染的患者进行比较。主要结局是血清白蛋白、蛋白能量营养不良（PEM）、白蛋白与球蛋白比值、预后营养指数（PNI）、全身免疫炎症指数、血小板与淋巴细胞比值、中性粒细胞与淋巴细胞比值和体重指数。共纳入 1546 名年龄 82.4±7.7 岁的患者，其中 55 名发生 SSI。两组患者的人口统计学和合并症相似。感染组抗凝治疗更为常见（32.7%比 13.9%，p<0.001），囊内骨折也更常见（60%比 42.9%，p=0.012）。在所有估计的指标中，只有 PNI 和 PEM 差异有统计学意义（研究组和对照组分别为 44.7±9.6 和 26.1%比 49.4±17.3 和 13.6%，p=0.002 和 0.027）。计算了逻辑回归模型以评估骨折类型和抗凝治疗作为可能混杂因素的贡献。回归后，这两个指标对感染的影响均有统计学意义，PEM 的比值比（OR）为 2.25（95%置信区间[CI]，1.089-4.344），PNI 的 OR 为 0.97（95%CI，0.937-0.996）。PNI 和 PEM 与 FHF 术后感染风险相关。由于这两个指标都可以通过易于获得的血液检查来计算，因此我们建议将其常规用于筛选有 SSI 风险的患者，以便进行有针对性的管理。
