Diagnostic Utility of Routine Serum Inflammatory Markers for Early Postoperative Infection, Hypoxia, and Hypotension After Fracture Surgery: A Prospective Cohort Study

Introduction Early detection of postoperative complications following fracture surgery remains challenging in resource-limited settings. Routine serum inflammatory markers, namely erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, and white blood cell (WBC) count, are readily available, cost-effective biomarkers that may help identify patients at risk of early complications such as fracture-related infection (FRI), hypoxia, and hypotension. Methods In this prospective observational cohort, 282 adults (18-65 years) with acute fractures presenting within 24 hours of trauma underwent surgical fixation at a tertiary care center between December 2022 and June 2024. Serial ESR, CRP, D-dimer, and WBC measurements were obtained from admission through postoperative day 14. Patients were monitored for FRI, hypoxia requiring oxygen therapy, and hypotension requiring inotropic support. Associations between biomarker trajectories, prespecified quantitative thresholds, and subsequent complications were analyzed. Results Of 282 patients (225 males, 57 females; mean age 39.31 years), a total of 50 patients (17.7%) developed complications: 26 (9.2%) FRI, 16 (5.7%) hypoxia, and 21 (7.5%) hypotension. CRP exhibited the strongest association with FRI; failure of CRP to decline and levels ≥30 mg/L around postoperative day 5 were frequently observed before clinical signs of infection. Elevated D-dimer levels, particularly preoperative values ≥4.0 mg/L and early postoperative values ≥3.0 mg/L, were associated with increased risk of hypoxia and hypotension, identifying a higher‑risk subgroup for closer hemodynamic and respiratory monitoring. ESR and WBC provided supportive but less discriminative information. Conclusion Serial CRP and D-dimer measurements offer practical, non-invasive tools for early risk stratification of postoperative infection, hypoxia, and hypotension after fracture surgery. Incorporating these markers into surveillance pathways may facilitate earlier recognition of deterioration and timelier intervention, especially in resource-constrained settings.