Sepsis Within 30 Days of Geriatric Hip Fracture Surgery.
BACKGROUND
Sepsis after hip fracture typically develops from one of the 3 potential infectious sources: urinary tract infection (UTI), pneumonia, and surgical site infection (SSI). The purpose of this investigation is to determine (1) the proportion of cases of sepsis that arises from each of these potential infectious sources; (2) baseline risk factors for developing each of the potential infectious sources; and (3) baseline risk factors for developing sepsis.


METHODS
The National Surgical Quality Improvement Program database was searched for geriatric patients (aged >65 years) who underwent surgery for hip fracture during 2005-2013. Patients subsequently diagnosed with sepsis were categorized according to concomitant diagnosis with UTI, SSI, and/or pneumonia. Multivariate regression was used to test for associations while adjusting for baseline characteristics.


RESULTS
Among the 466 patients who developed sepsis (2.4% of all patients), 157 (33.7%) also had a UTI, 135 (29.0%) also had pneumonia, and 36 (7.7%) also had SSI. The rate of sepsis was elevated in patients who developed UTI (13.0% vs 1.7%; P < .001), pneumonia (18.2% vs 1.8%; P < .001), or SSI (14.8% vs 2.3%; P < .001). The mortality rate was elevated among those who developed sepsis (21.0% vs 3.8%; P < .001).


CONCLUSION
Sepsis occurs in about 1 in 40 patients after geriatric hip fracture surgery. Of these septic cases, 1 in 3 is associated with UTI, 1 in 3 with pneumonia, and 1 in 15 with SSI. The cause of sepsis is often unknown on clinical diagnosis, and this distribution of potential infectious sources allows clinicians for direct identification and treatment.
['Bohl|Daniel D|DD|', 'Iantorno|Stephanie E|SE|', 'Saltzman|Bryan M|BM|', 'Tetreault|Matthew W|MW|', 'Darrith|Brian|B|', 'Della Valle|Craig J|CJ|']
D000368:Aged D000369:Aged, 80 and over D005260:Female D006620:Hip Fractures D006801:Humans D015994:Incidence D008297:Male D011014:Pneumonia D011183:Postoperative Complications D058996:Quality Improvement D012307:Risk Factors D018805:Sepsis D013530:Surgical Wound Infection D014481:United States D014552:Urinary Tract Infections
sepsis hip fracture urinary tract infection pneumonia surgical site infection