Litten Robin M, Alcaide Doriann M, Rutz Robert W, Benson Elizabeth M, Carter Karen J, Gross Evan G, McIlwain Ryan N, Heatherly Alex R, Yeager Matthew T, Stripling Joshua T, Spitler Clay A, Johnson Joey P
University of Alabama at Birmingham, Birmingham, USA.
Eur J Orthop Surg Traumatol. 2025 Jul 24;35(1):320. doi: 10.1007/s00590-025-04444-9.
Fracture-related infection (FRI) is a serious complication of orthopedic trauma that can result in systemic complications affecting multiple organ systems. While diagnostic criteria have become standardized, predictors of systemic complications remain poorly understood. This study aimed to evaluate factors associated with the development of systemic complications following operative FRI management.
We conducted a retrospective cohort study at a single Level I trauma center from 2013 to 2021. Adult patients with postoperative FRI requiring hospitalization and surgical treatment were included. Patients required either six months of follow-up or development of a systemic complication before that point. Systemic complications included cerebrovascular accident (CVA), myocardial infarction (MI), acute respiratory distress syndrome (ARDS), deep vein thrombosis/pulmonary embolism (DVT/PE), acute kidney injury (AKI), sepsis, and mortality. Demographics, comorbidities, injury characteristics, lab values, and operative details were compared between patients with and without complications.
A total of 281 patients with FRI were included, with 70 (24.9%) experiencing systemic complications. The mean age of patients with complications was significantly higher (51.7 years) compared to those without (43.8 years, p < 0.001). Systemic complications included sepsis (11.7%), AKI (8.2%), DVT/PE (5.0%), and mortality (2.5%). Patients with complications had higher body mass index (BMI) (31.6 kg/m vs. 29.5 kg/m, p = 0.054), a greater prevalence of diabetes (30.0% vs. 16.1%, p = 0.011), cardiovascular disease (CVD) (42.9% vs. 23.2%, p = 0.002), chronic obstructive pulmonary disease (COPD) (20.0% vs. 4.7%, p < 0.001), prior CVA (11.4% vs. 1.4%, p < 0.001), chronic kidney disease (CKD) (18.6% vs. 3.3%, p < 0.001), and higher Charlson Comorbidity Index (CCI) (2.2 vs. 1.0, p < 0.001). No significant differences were observed in fracture characteristics, operative details, or preoperative laboratory values (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], albumin, prealbumin) between the groups. Multivariate analysis identified higher CCI as an independent risk factor for systemic complications (OR 1.83, 95% CI 1.31-2.57; p = 0.001).
Patient characteristics such as age, diabetes, CVD, COPD, CVA, CKD, and CCI differed significantly in patients with FRI who experienced systemic complications from those without. CCI was an independent risk factor for systemic complications following FRI.
Patient characteristics such as age, diabetes, CVD, COPD, CVA, CKD, and CCI differed significantly in patients with FRI who experienced systemic complications from those without. CCI was an independent risk factor for systemic complications following FRI. III.
骨折相关感染（FRI）是骨科创伤的一种严重并发症，可导致影响多个器官系统的全身并发症。虽然诊断标准已标准化，但全身并发症的预测因素仍知之甚少。本研究旨在评估手术治疗FRI后全身并发症发生相关的因素。
我们在一家一级创伤中心于2013年至2021年进行了一项回顾性队列研究。纳入术后FRI需要住院和手术治疗的成年患者。患者需要随访6个月或在此之前发生全身并发症。全身并发症包括脑血管意外（CVA）、心肌梗死（MI）、急性呼吸窘迫综合征（ARDS）、深静脉血栓形成/肺栓塞（DVT/PE）、急性肾损伤（AKI）、脓毒症和死亡。对有并发症和无并发症患者的人口统计学、合并症、损伤特征、实验室检查值及手术细节进行比较。
共纳入281例FRI患者，其中70例（24.9%）发生全身并发症。有并发症患者的平均年龄（51.7岁）显著高于无并发症患者（43.8岁，p<0.001）。全身并发症包括脓毒症（11.7%）、AKI（8.2%）、DVT/PE（5.0%）和死亡（2.5%）。有并发症患者的体重指数（BMI）更高（31.6kg/m²对29.5kg/m²，p=0.054），糖尿病患病率更高（30.0%对16.1%，p=0.011）、心血管疾病（CVD）（42.9%对23.2%，p=0.002）、慢性阻塞性肺疾病（COPD）（20.0%对4.7%，p<0.001）、既往CVA（11.4%对1.4%，p<0.001）、慢性肾脏病（CKD）（18.6%对3.3%，p<0.001），且Charlson合并症指数（CCI）更高（2.2对1.0，p<0.001）。两组间骨折特征、手术细节或术前实验室检查值（白细胞[WBC]计数、红细胞沉降率[ESR]、C反应蛋白[CRP]、白蛋白、前白蛋白）无显著差异。多因素分析确定较高的CCI是全身并发症的独立危险因素（OR 1.83，95%CI 1.31-2.57；p=0.001）。
发生全身并发症的FRI患者与未发生全身并发症的患者在年龄、糖尿病、CVD、COPD、CVA、CKD和CCI等患者特征方面存在显著差异。CCI是FRI后全身并发症的独立危险因素。
发生全身并发症的FRI患者与未发生全身并发症的患者在年龄、糖尿病、CVD、COPD、CVA、CKD和CCI等患者特征方面存在显著差异。CCI是FRI后全身并发症的独立危险因素。三级。
