Critical Analysis of Predictors of Postoperative Nosocomial Infection in Patients Undergoing Corrective Surgery for Hip Fracture: Impact of Comorbidities and Preoperative Care

Hip fractures are associated with high morbidity and mortality, especially in older adults. Literature on infectious complications in this context is scarce in developing countries. This study aimed to identify factors associated with infections in hip-fracture patients undergoing surgery. This was a retrospective cohort study conducted at Hospital Estadual de Diadema. A total of 1,338 patients aged 60 years or older, hospitalized for hip fracture and undergoing surgical repair between 2018 and 2024, were included. Demographic, clinical, trauma-related, hospital care–related, and outcome data were collected. Logistic regression analyses were conducted to identify factors associated with infections during hospitalization. Median age was 79 years (interquartile range [IQR] 71–85), and 900 (67%) were female. Femoral neck fractures were observed in 760 (56.8%) cases and intertrochanteric fractures in 578 (43.2%). Median length of stay was 9 days (IQR 6–13). Postoperative infectious complications occurred in 354 (26%) patients; the most common were urinary tract infection (18%), pneumonia (9.8%), and sepsis (2.5%). In-hospital mortality was 12.2% (n = 146), of which 57% were associated with infection. All infections correlated with higher mortality. Patients with infection had a length of stay twice as long. In multivariate analysis, advanced age (4% increase in infection risk per year; 95% CI 1.02–1.05), comorbidities (Charlson Comorbidity Index ≥1; OR = 1.34; 95% CI 1.03–1.76), type of surgery (arthroplasty vs osteosynthesis; OR = 1.45; 95% CI 1.12–1.89), and longer time from admission to surgery (OR = 1.12 per day; 95% CI 1.08–1.16) were independently associated with infection. Infections are frequent in hip-fracture patients undergoing surgery and are associated with worse clinical course and higher mortality. The observed infection rate was higher than that described in developed countries. Advanced age, comorbidities, femoral neck fracture, and prolonged time to surgery increase infection risk. Strategies that reduce time to surgery and optimize care for vulnerable patients are essential to mitigate infectious complications in this population. The data may help optimize perioperative care and resource allocation.