Fracture-related infection after internal fixation of pelvic and acetabular fractures : a population-based analysis of risk factors and economic costs.

Abstract

Fracture-related infection (FRI) is a relatively common and severe complication following operatively managed fractures. Patients with pelvic and acetabular fractures (PAFs) are a high-risk patient group, represent high injury severity, and are often polytraumatized. The aims of this study are to characterize a population-based cohort of patients with PAF complicated by FRI, to identify factors associated with the development of FRI and estimate the health economic burden. A retrospective analysis of a ten-year population-based, person-linked dataset was performed, including all PAF patients undergoing internal fixation within Queensland, Australia. Demographic and clinical variables were collected and included into a multivariable logistic regression. Health economic variables were compared between infected and uninfected PAF patients. There were 842 patients who sustained a PAF and underwent operative stabilization, of which 52 (6.4%) were complicated by FRI. Open fractures, increased length of stay, and rural residence were associated with an increased risk of development of FRI. Direct inpatient costs for managing FRI were higher at a median $AUD 69,088 (IQR $44,338 to $104,297) versus $AUD 40,904 (IQR $27,803 to $59,371) for uninfected PAF management. The health economic impact is significant, with infected patients staying 2.5 times longer in hospital and costing 1.7 times more in direct inpatient costs compared to uninfected patients.