Is pelvic arterial angioembolization associated with increased infection risk following pelvic fracture fixation?

Angiography with or without embolization is commonly performed in patients with pelvic fractures and suspected arterial bleeding. While this intervention is often life-saving, concerns remain regarding its potential impact on postoperative infection following surgical fixation. This study aims to evaluate the relationship between angiography, angioembolization, and postoperative infection in operatively managed pelvic fractures.

This retrospective cohort study utilizes 2017-2021 data from the American College of Surgeons Trauma Quality Improvement Program (TQIP) to investigate the relationship between pelvic angiography/angioembolization and postoperative infection in patients undergoing surgical fixation for pelvic or acetabular fractures. Adult patients undergoing operative fixation for pelvic or acetabular fractures were stratified into three groups: no angiography, angiography only, and angiography with embolization. The primary outcome was pooled infection (superficial, deep, organ space surgical site infections, and osteomyelitis). Multivariable logistic regression was used to adjust for injury severity and other confounders.

A total of 107,748 patients were included. Unadjusted analysis showed increased pooled infection rate in patients undergoing angiography or angioembolization (2.7 %) compared to no angiography (1.2 %, p < 0.001). Multivariate regression suggested that this association was likely due to higher injury severity and hypotension rather than the procedure itself, as Injury Severity Score (ISS) and hypotension were significantly associated with increased infection risk. Analysis of secondary endpoints showed an independent association between angioembolization and osteomyelitis (OR 1.86, 95 % CI 1.06-3.25).

Angiography is not independently associated with an increased risk of infections following pelvic fracture surgery. Additionally, angioembolization does not independently increase infection risk overall, but is associated with an increased risk of postoperative osteomyelitis.

Level 3.