Müller Franz, Zellner Michael, Bäuml Christian, Proske Andreas, Füchtmeier Bernd, Wulbrand Christian
Clinic for Orthopaedic, Trauma and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Germany.
J Orthop Traumatol. 2025 Jun 4;26(1):35. doi: 10.1186/s10195-025-00856-9.
Surgical site infection (SSI) is a major postoperative complication following internal fixation or arthroplasty for proximal femoral fracture (PFF). Few studies have examined the potential risk factors for SSI; therefore, we conducted this matched-pair analysis.
This single-centre study was based on a retrospective database of patients treated for PFF with internal fixation or arthroplasty between 2006 and 2024. Patients with revision for SSI were enrolled and matched with an uneventfully treated group at a 1:3 ratio. Matching was performed on the basis of sex, age, body mass index, diagnosis and treatment. The primary outcomes were risk factors for SSI. The secondary outcomes were risk factors for mortality, as determined by multivariate Cox regression analysis.
Initially, a total of 5000 patients were enrolled. The mean follow-up was 11.7 years. The total SSI rate was 2.8% (140/5,000). Ultimately, 130 patients with confirmed SSI and 390 matched patients were enrolled in this study. Most of the SSIs were Staphylococcus aureus, followed by Staphylococcus epidermidis. The factors that significantly influenced SSI were female sex, American Society of Anaesthesiologists (ASA) score of 4, dementia, atrial fibrillation, and the number of red blood transfusions (≥ 3 units). The mean survival duration of the total cohort was 4.2 years (SD ± 3.38). The 30-day, 3-month and 1-year all-cause mortality rates of patients with SSIs were 5.4%, 25.4%, and 40%, respectively. Multivariate Cox regression revealed that SSI was an independent risk factor for mortality (hazard ratio 1.59; 95% confidence interval 1.28-1.98; p < 0.001), Further risk factors for mortality were living in a retirement home, reduced mobility, anaemia at admission, elevated C-reactive protein, ASA score 3 or 4, intraoperative blood loss greater than 400 ml, Charlson comorbidity index score above ≥ 1, dementia and renal insufficiency.
In this study, patients with SSI following surgery of PFF had a significantly shorter survival time than patients in the uneventfully treated matched-pair group. Most risk factors associated with SSI are unaffected. Fortunately, the rate of SSI was low and decreased significantly within the study period.
III; clinical case series with matched pair controls.
手术部位感染（SSI）是股骨近端骨折（PFF）内固定或关节置换术后的主要术后并发症。很少有研究探讨SSI的潜在危险因素；因此，我们进行了这项配对分析。
这项单中心研究基于2006年至2024年间接受PFF内固定或关节置换治疗的患者的回顾性数据库。纳入因SSI进行翻修的患者，并与治疗过程顺利的组按1:3的比例进行配对。根据性别、年龄、体重指数、诊断和治疗进行配对。主要结局是SSI的危险因素。次要结局是通过多变量Cox回归分析确定的死亡危险因素。
最初，共纳入5000例患者。平均随访时间为11.7年。总SSI发生率为2.8%（140/5000）。最终，130例确诊为SSI的患者和390例配对患者纳入本研究。大多数SSI由金黄色葡萄球菌引起，其次是表皮葡萄球菌。显著影响SSI的因素为女性、美国麻醉医师协会（ASA）评分为4、痴呆、心房颤动以及红细胞输注量（≥3单位）。整个队列的平均生存时间为4.2年（标准差±3.38）。发生SSI的患者30天、3个月和1年的全因死亡率分别为5.4%、25.4%和40%。多变量Cox回归显示，SSI是死亡的独立危险因素（风险比1.59；95%置信区间1.28 - 1.98；p < 0.001），死亡的进一步危险因素包括住在养老院、活动能力下降、入院时贫血、C反应蛋白升高、ASA评分为3或4、术中失血大于400 ml、Charlson合并症指数评分≥1、痴呆和肾功能不全。
在本研究中，PFF手术后发生SSI的患者的生存时间明显短于治疗过程顺利的配对组患者。大多数与SSI相关的危险因素未受影响。幸运的是，SSI发生率较低，且在研究期间显著下降。
III；有配对对照的临床病例系列。
