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Hip Fractures in the Elderly: How to avoid Surgical Site Infections and Improve Outcomes

Hip fractures in the elderly results in a loss of physical function, decreased social engagement, increased dependence and worse quality of life, beyond suffering pain. One in three adults aged 50 and over dies within 12 months of suffering a hip fracture. Older adults have a five-to-eight times higher risk of dying within the first three months of a hip fracture compared to those without a hip fracture. This increased risk of death remains for almost ten years.

Combined with trauma surgery, an existing health condition may significantly increase the risk of death. Death after a hip fracture may also be related to additional complications of the fracture, such as infections, internal bleeding, stroke or heart failure. 

One study showed heart disease, stroke and pneumonia resulted in a long-term doubling of the risk of death after hip fracture, and this risk remained high for up to ten years in women and 20 in men.

Studies suggest issues related to hospitalization, surgery, or immobility (which could put patients at risk of pneumonia) after a fracture leads to other complications that ultimately result in earlier death.

Surgical Site Infections

Surgical site infection (SSI) after hip surgery is a devastating complication for patients, especially for the elderly. In recent years, the incidence of hip fracture is on the rise, attracting more and more attention to orthopedic surgeons. It has been reported that the 1-year mortality of geriatric patients with hip fractures is 26 ~ 29%, and the 2-year mortality is 38%.

Advanced age is prone to a higher incidence of SSI. One explanation for this is that the presence of comorbidities will often cause an individual to have a much lower baseline exercise tolerance compared with those who are systemically well.

As a vital indicator in orthopedics and other disciplines, operating time affects the incidence of SSI in many ways. A longer operation duration may attribute to the difficulty of the surgical procedure and this condition may lead to extensive tissue stripping, prolonged exposure of incision to some potential infectious factors.

How can patient outcomes be improved?

Patients should receive therapeutic rehabilitation and functional training for the best chance of regaining mobility. Therapeutic rehabilitation may include improving the range of motion, pool therapy, and strengthening and progressive resistance exercises. Functional training will include gait training and balance exercises. 

Some data suggest beginning physical activity as soon as possible post-surgery will reduce the likelihood of death. There are not known results about the type, intensity, and duration of physical activity that will give the best results.

Nutrition can also help recovery. Some data has shown poor nutrition at the time of the fracture reduced people’s ability to walk unaided six months after the fracture, compared to those with good nutrition.

There are mixed messages regarding whether nutritional supplements help improve function after a hip fracture. But the combination of protein intake and physical activity is known to increase muscle mass and function. Good muscle mass and function reduce frailty and improve balance, thereby reducing the risk of falls and subsequent fracture.

And there are additional benefits to be gained from being physically active, such as reducing depression – particularly when exercising with other people.

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