Thurs., 10/4/12 Hip Fractures, PAPER #37, 4:35 pm OTA-2012
Postoperative Urinary Tract Infection Results in Higher Rates of Deep Infection in Patients With Proximal Femoral Fractures
Benjamin J. Ollivere, FRCS, MBBS, MD; Thomas Kurien, MBBS; Claire Morris, MA;
Daren P. Forward, FRCS; Christopher G. Moran, MD, FRCS;
Queens Medical Centre, Nottingham, United Kingdom
Purpose: Patients presenting with a fractured neck of femur are a fragile group with multiple comorbidities who are at risk of postoperative complications. As many as 52% of patients are reported to suffer a urinary tract infection (UTI) after hip fracture surgery. As there are little data surrounding the effects of postoperative UTIs on mortality and deep prosthetic infection, we aim to investigate the effects of a perioperative UTI.
Methods: We prospectively investigated the impact of postoperative UTI in 9168 patients admitted to our institution with a diagnosis of proximal femoral fracture over an 11-year period in a prospective population study. We examined the effects of postoperative UTI on the incidence of deep infection, survivorship, and length of stay.
Results: Postoperative UTI occurred in 6.1% (n = 561) and deep infection in 0.89% (n = 82). Deep infection was significantly more common in patients complicated with a UTI (3.2% vs 0.74%, P <0.001) with a relative risk of 3.7:1. In 58% of patients the same organism was cultured in the urine and hip samples. A postoperative UTI did not adversely affect 90-day survival; however, it was associated with an increased length of stay (receiver operating curve [ROC] analysis, area under the curve [AUC] = 0.79). Delays to surgery and age were not predictive of a postoperative UTI.
Conclusion: Recognition of the risks posed by postoperative UTI and the risk factors for development of infection, and early treatment are essential to reduce the risks of increased subsequent periprosthetic infection.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.