Postoperative urinary tract infection linked to deep infection after hip fracture surgery

The retrospective analysis revealed that urinary tract infection was associated with longer duration hospital stays.

Issue: January 2013

MINNEAPOLIS — Investigators from the United Kingdom cited postoperative urinary tract infection as a significant risk factor of deep infection and longer hospital stay after treatment for proximal femoral fracture, according to a study presented here.

Perspective from Morten Schultz Larsen, MD

“Our conclusion was that aggressive prevention and treatment of [urinary tract infection] UTI should reduce length of stay, associated costs and deep infection rates,” Benjamin J. Ollivere, FRCS, MBBS, MD, a trauma fellow at Queens Medical Centre, in Nottingham, United Kingdom, said when he presented the findings at the Orthopaedic Trauma Association Annual Meeting.

Ollivere and colleagues performed a retrospective analysis of prospectively collected data on 9,168 patients with proximal femur fractures treated during an 11-year period. The patients were followed up to death or revision.

Benjamin J. Ollivere, FRCS, MBBS, MD — Benjamin J. Ollivere

UTI associated with infection

The investigators found 6.1% of patients had a postoperative UTI and 0.89% developed a deep infection.

“We found a significant association,” Ollivere said during his presentation.

Of the 561 patients with a UTI, 18 patients developed a deep infection. Of the 8,607 patients without a UTI, 64 patients had a deep infection.

Ollivere added, “Interestingly, 58% [of patients had] the same organism in the urine and the deep tissue taken at revision.”

Link to hospital stays

In the study, UTI was also significantly associated with an increased length of hospital stay. The investigators found higher 30-day mortality in patients who did not have a UTI.

“We think this is probably a confounder, because the patients who die early, you do not observe them for long enough [so] they do not develop their UTI later on.”

However, the researchers found no significant differences between the postoperative UTI group and those without the condition for 90-day and 1-year mortalities, delay to surgery, and age. – by Gina Brockenbrough, MA

Reference:
Ollivere BJ. Paper #37. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 3-6, 2012; Minneapolis.

For more information:
Benjamin J. Ollivere, FRCS, MBBS, MD, can be reached at Derby Road, Nottingham NG7 2UH, United Kingdom; email: ben@ollivere.co.uk.

Disclosure: No authors have relevant financial disclosures.

Perspective

Morten Schultz Larsen, MD

It is well known and well documented that elderly patients with proximal femoral fractures have high complication rates. Many of these are related to surgery but we also need to focus on postoperative complications that are not directly related to surgery.

This robust study reminds us that postoperative urinary tract infection should be prevented and, if it is not, the risk of deep infection is almost four times higher.

Confusion, decubitus ulcers, and pneumonia are other examples of complications that needs attention.

The best way to improve results for the fragile patients is probably through a very structured treatment course. Preoperative comorbidity must be recognized and treatment optimized and patients must be carefully monitored and mobilized as early as possible. This is a time consuming and complex task that may warrant a multidisciplinary approach.

Morten Schultz Larsen, MD

Orthopaedics Today Europe Editorial Board member

Head of Trauma Department

Associate Professor

Department of Orthopaedics

Odense University Hospital

Odense, Denmark

Disclosures: Schultz Larsen has no relevant financial disclosures.