Surgical site infection and associated risk factors in elderly patients undergoing hip arthroplasty: a systematic review and meta-analysis

Fracture of the femoral neck, prevalent among the elderly, is typically managed through total hip arthroplasty or hemiarthroplasty. In this demographic, there is an increased risk of surgical site infections (SSIs), contributing to extended hospital stays, increased morbidity, and mortality. This study aims to determine the incidence rate of SSIs following hip surgery in the elderly and to identify associated risk factors. A comprehensive search of MEDLINE/PubMed, Embase, and the Cochrane Library was conducted for relevant studies published up to May 2024. Observational studies reporting the incidence rate of SSIs and associated risk factors were included in this analysis. The primary outcome was the incidence rate of SSIs post-hip surgery, along with potential risk factors. This study is registered with PROSPERO (ID: CRD42024583178) and adheres to the PRISMA guidelines. Seven studies were included in the analysis. The pooled incidence rate of hip SSIs was 1.98% (95% CI: 0.96-4.11). Analysis of risk factors revealed that patients with a BMI≥35 had a significantly increased risk of SSIs in the hip joint [OR 4.01 (95% CI: 2.55-6.31)]. However, the pooled analysis indicated that diabetes mellitus [OR 1.65 (95% CI: 0.80-3.39)] and age≥67 years [OR 1.85 (95% CI: 0.29-11.75)] were not significantly associated with an increased risk of hip SSIs. Our study concludes that obesity is a significant risk factor for the development of surgical site infections in elderly patients following hip surgery.