Background: Surgical site infection (SSI) after fragility hip fracture (FHF) surgery is associated with increased morbidity and mortality. We aim to utilize several established nutritional and inflammatory indices to characterize patients at risk. Patients and Methods: A retrospective cohort study of patients 65 years and older, who underwent surgery following FHFs between January 2012 and June 2020. Those patients who presented with post-operative infection in the year after surgery were compared with patients who did not. The primary outcomes were serum albumin, protein energy malnutrition (PEM), albumin to globulin ratio, prognostic nutritional index (PNI), the systemic immune inflammation index, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and body mass index. Results: A total of 1,546 patients, ages 82.4 ± 7.7, were included; 55 of whom presented with SSI. Demographics and comorbidities were similar. Anticoagulation treatment was more prevalent in the infected group (32.7% vs. 13.9%, p < 0.001) as were intra-capsular fractures (60% vs. 42.9%, respectively; p = 0.012). Of all indices estimated, only the PNI and the PEM were found to differ significantly (44.7 ± 9.6 and 26.1% vs. 49.4 ± 17.3 and 13.6% for the study and control groups respectively; p = 0.002 and 0.027). A logistic regression model was calculated to evaluate the contribution of fracture type and anticoagulation treatment as possible confounders. Both indices were found to be significant for infection after regression odds ratio, 2.25 for PEM; (95% confidence interval [CI], 1.089-4.344) and odds ratio, 0.97 for PNI (95% CI, 0.937-0.996). Conclusions: The PNI and the PEM were found to correlate with infection risk after FHF surgery. As both can be easily calculated from an accessible blood test, we recommend their routine use as a screening tool for tailored management of patients at risk for SSI.

中文翻译：

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营养和炎症指数以及脆性髋部骨折后手术部位感染的风险：常规血液检查能否表明患者存在风险？

背景：脆性髋部骨折（FHF）术后手术部位感染（SSI）与发病率和死亡率增加相关。我们的目标是利用几种已建立的营养和炎症指数来描述处于危险中的患者的特征。患者和方法：一项回顾性队列研究，对象为 2012 年 1 月至 2020 年 6 月期间 FHF 后接受手术的 65 岁及以上患者。将那些在术后一年内出现术后感染的患者与未出现术后感染的患者进行比较。主要结局是血清白蛋白、蛋白能量营养不良（PEM）、白蛋白与球蛋白比率、预后营养指数（PNI）、全身免疫炎症指数、血小板与淋巴细胞比率、中性粒细胞与淋巴细胞比率和体重指数。结果：共纳入 1,546 名患者，年龄 82.4 ± 7.7 岁；其中 55 人接受了 SSI。人口统计学和合并症相似。抗凝治疗在感染组中更为普遍（32.7% vs. 13.9%，p < 0.001），囊内骨折也更为普遍（分别为 60% vs. 42.9%；p = 0.012）。在所有估计的指数中，只有 PNI 和 PEM 存在显着差异（研究组和对照组分别为 44.7 ± 9.6 和 26.1%，对比 49.4 ± 17.3 和 13.6%；p = 0.002 和 0.027）。计算逻辑回归模型来评估骨折类型和抗凝治疗作为可能的混杂因素的贡献。回归比值比（PEM 为 2.25）后，发现这两个指数对于感染均具有显着性；（95% 置信区间 [CI]，1.089-4.344）PNI 的优势比为 0.97（95% CI，0.937-0.996）。结论：PNI 和 PEM 与 FHF 手术后感染风险相关。由于两者都可以通过可访问的血液测试轻松计算，因此我们建议常规使用它们作为筛查工具，对有 SSI 风险的患者进行量身定制的管理。