Risk factors for postoperative infection after non-elective femur fracture fixation in pediatric patients.

Abstract

Pediatric femoral shaft fractures are common and often require surgical fixation. Postoperative infections remain a serious complication, yet risk factors specific to this population are not well defined. We analyzed 14,037 pediatric patients undergoing non-elective femur fracture fixation in the 2019 and 2022 Kids' Inpatient Database (KID). Multivariable logistic regression identified independent predictors of postoperative soft tissue, device-related, and overall infection. Secondary outcomes included length of stay (LOS) and hospital charges. Infections occurred in 0.6% of patients (0.4% soft tissue, 0.3% device-related). Nondisplaced fractures had sharply increased odds of device infection (OR 35.2, 95% CI 4.7-189.7, p < 0.001), while open fractures were protective (OR 0.12, 95% CI 0.01-0.58, p = 0.039). External fixation conferred the highest infection risk versus intramedullary nailing (OR 4.65, 95% CI 2.25-9.13, p < 0.001). Blood transfusion consistently predicted infection across categories (OR 2.6-3.5, all p < 0.01). Soft tissue infection prolonged LOS (20.5 vs 4.2 days, p < 0.001) and raised hospital charges ($421,798 vs $111,845, p < 0.001). This study identifies novel and actionable risk factors for postoperative infection following pediatric femur fracture fixation. Recognition of high-risk groups, including those receiving external fixation or transfusion, may guide targeted prevention, perioperative optimization, and surveillance strategies. These findings have important implications for surgical decision-making and healthcare resource utilization in pediatric orthopedic trauma.