Capturing surgical site infection after hip fracture surgery

Listen to Simon and Amy discuss the paper 'Capturing surgical site infection after hip fracture surgery' published in the November 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper 'Capturing surgical site infection after hip fracture surgery' published in November 2025 by J Masters, D Metcalfe, ML Costa and A Judge. I am Simon and I'm joined by my co-host Amy.

Hello everyone. This study explores a significant concern in orthopaedic surgery, particularly among older adults, the occurrence of surgical site infections following hip fracture surgery. The research aims to evaluate how often these infections occur, the timing of their diagnosis, and the limitations of using routinely collected data to identify them.

Hip fractures are becoming increasingly common as the population ages and while surgery is effective in restoring mobility, it comes with risks such as surgical site infections. These infections can significantly hinder recovery, prolonged hospitalization times, and even lead to higher mortality rates.

The authors conducted a retrospective cohort study using linked [00:01:00] primary and secondary care datasets, specifically the Clinical Practice Research Datalink, CPRD and Hospital Episode Statistics, HES data, spanning from 1999 to 2013. They included 13,920 hip fracture patients and compared them with age and sex-matched controls.

One of the key findings was that 2.4% of the patients developed a definite surgical site infection with most infections identified through CPRD. Interestingly, 43% of these infections were diagnosed more than 90 days after surgery. This delayed identification really emphasizes the need for extended follow-up.

The study also found that a higher Charlson Comorbidity Index, CCI, equal to or greater than three, was significantly associated with an increased risk of surgical site infection. This index measures the burden of coexisting conditions, and a higher score indicates a higher risk for postoperative complications.

The methods for identifying surgical site infections were meticulous. [00:02:00] They used specific diagnostic codes and categorize them as either definite or possible. Surgical site infections, necessitate in reoperation were identified using detailed HES procedure codes, making sure to include various types of surgeries like washouts, debridement, and complete revisions, and the data sources they used CPRD and HES each have their strengths. CPRD contains anonymized primary care records, including diagnoses and prescriptions, while HES provides detailed administrative data from secondary care episodes. However, the study found limited overlap between these datasets, suggesting that many surgical site infections might be under-reported in routine data.

Interestingly, the median time to infection diagnosis differed between the two datasets, being shorter in CPRD compared to HES, which may highlight some limitations in hospital outpatient coding, or delayed transcription of diagnoses. Exactly, the study also noted that administrative [00:03:00] datasets might miss cases diagnosed and managed outside the initial hospital admission, often appearing weeks or months post-surgery. This underscores the importance of integrating primary care data for more comprehensive surveillance.

Despite these challenges, the study's use of linked datasets provided valuable insights. They found that while traditional surveillance methods might miss late diagnosed infections, administrative data can still offer large-scale observation of infection trends and patient outcomes.

This research greatly contributes to understanding the incidents of surgical site infections in hip fracture patients, and highlights the need for improved data integration and extended follow-up to capture the true burden of these infections. It also points to the necessity of enhanced prevention strategies and optimized antibiotic use to mitigate these risks.

Indeed. Before we wrap up, let's reiterate the key takeaways from today's discussion. First surgical site infections following hip fracture surgery are significant, but often [00:04:00] under-reported. Second, the timing of infection diagnoses varies widely indicating a need for extended monitoring. Finally, improved data integration between primary and secondary care records is essential for accurate infection surveillance and quality improvement.

Couldn't have said it better, Simon. Thank you all for tuning into AI Talks with Bone & Joint. Stay with us for more insightful episodes. Until next time, goodbye everyone.