Risk factors for persistent wound drainage after hemiarthroplasty in elderly hip fracture patients

This study aims to evaluate the risk factors for persistent wound drainage (PWD) and its impact on in-hospital outcomes among geriatric patients with hip fractures treated with hemiarthroplasty.

A total of 265 hip fracture patients (91 males, 174 females; median age: 83 years; range, 65 to 99 years) who underwent hip hemiarthroplasty between June 2019 and June 2025 were retrospectively analyzed. Demographics, comorbidities, laboratory findings, and preoperative medications were evaluated. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of PWD.

Sixty-one (23.0%) patients were diagnosed with PWD. Low postoperative Day 1 serum albumin level (odds ratio [OR]= 0.85, 95% confidence interval [CI] 0.79-0.92, p < 0.001), preexisting hypertension (OR = 2.50, 95% CI 1.15-5.39, p = 0.020), and chronic warfarin use (OR = 8.15, 95% CI 2.20-30.14, p = 0.002) were identified as independent predictors of PWD. The optimal cut-off for the postoperative Day 1 serum albumin level was 30.5 g/L (sensitivity: 60.7%, specificity: 76.5%). In the PWD group, in-hospital mortality rates (16.4% vs. 5.9%, p = 0.009), mean length of hospital stay (17.7 ± 11.8 days vs. 7.4 ± 6.3 days, p = 0.000), and the incidence of sacral decubitus ulcers (26.2% vs. 10.8%, p = 0.003) were significantly higher. Rates of both superficial and deep wound infections were also significantly elevated in the PWD group (p < 0.001 and p = 0.003, respectively).

Low postoperative albumin, preexisting hypertension, and chronic warfarin use are significant predictors of PWD following hemiarthroplasty in elderly patients with hip fractures, and the existence of PWD was associated with increased in-hospital morbidity and mortality. Early identification and preventive strategies targeting at-risk patients may improve outcomes.