Tracking patients with lower-extremity fracture in a trauma registry who develop an infection after discharge

Lower-extremity fracture infections in patients with trauma represent a substantial burden; however, quality improvement initiatives are limited to the acute hospital admission, for a complication that often develops after discharge. We tracked patients with a lower-extremity fracture who developed an infection after discharge from their index trauma center admission and characterized factors associated with this complication using collaborative quality initiative data.

Trauma collaborative quality initiative data (1/2018-9/2022) were analyzed from 35 American College of Surgeons Committee on Trauma-verified Level 1 and Level 2 trauma centers and were linked to insurance claims to create a longitudinal patient record. Inpatient and postdischarge lower-extremity fracture infection rates and the location of subsequent follow-up were captured. Multivariable logistic regression assessed the factors associated with developing a postdischarge infection.

There were 11,017 patients with a lower-extremity fracture and 380 (3.4%) developed an infection after discharge, and very few during the index trauma center admission. An open injury increased the probability of an infection by 3.61 percentage points, along with male sex (0.93 percentage points) and multiple medical comorbidities. Almost two-thirds of the infections were diagnosed at a location other than the index trauma center.

The overwhelming majority of lower-extremity fracture infections occur after discharge from the index trauma center, and most patients seek care at another location. Known risk factors for developing an infection were confirmed in this large population-based cohort. We successfully linked trauma registry patients with insurance claims to create a longitudinal patient record, which will allow for further studies in this population.