Nutritional and Inflammatory Indices and the Risk of Surgical Site Infection After Fragility Hip Fractures: Can...

Area of Science:

• Geriatric Surgery
• Orthopedic Surgery
• Infectious Disease Epidemiology

Background:

• Surgical site infection (SSI) following fragility hip fracture (FHF) surgery significantly increases patient morbidity and mortality.
• Identifying patients at risk for SSI is crucial for implementing preventative strategies and improving surgical outcomes.

Purpose of the Study:

• To evaluate the utility of various nutritional and inflammatory indices in predicting SSI risk in elderly patients undergoing FHF surgery.
• To determine if prognostic nutritional index (PNI) and protein energy malnutrition (PEM) can serve as effective screening tools for SSI risk.

Main Methods:

• A retrospective cohort study analyzed 1,546 patients aged 65+ who underwent FHF surgery between 2012 and 2020.
• Patients were divided into two groups: those who developed post-operative SSI and those who did not.
• Nutritional indices including PNI and PEM, alongside inflammatory markers, were assessed and compared between groups.

Main Results:

• Of 1,546 patients, 55 developed SSI. The infected group showed higher prevalence of anticoagulation treatment and intra-capsular fractures.
• Prognostic nutritional index (PNI) and protein energy malnutrition (PEM) were significantly different between the SSI and control groups (p=0.002 and p=0.027, respectively).
• Logistic regression confirmed PEM (OR 2.25) and PNI (OR 0.97) as significant predictors of SSI, even after adjusting for fracture type and anticoagulation.

Conclusions:

• PNI and PEM are significant indicators of infection risk following FHF surgery.
• These indices, calculable from routine blood tests, are recommended as screening tools for early identification and tailored management of patients at risk for SSI.