Factors Associated with Pelvic Infection after PrePeritoneal Pelvic Packing for Unstable Pelvic Fractures

Author(s):
Husayn Ladhani; Caitlyn McCall; Chelsea Horwood; Nicole Werner; Ryan Lawless; Barry Platnick; Ernest Moore; Eric Campion; Daniel VanDerPloeg; Fredric Pieracci; Clay Cothren Burlew

Background:

At our institution patients with unstable pelvic fractures and hemodynamic instability are taken to the OR for preperitoneal pelvic packing (PPP) and external fixation of the pelvis. Pelvic infection (PI) can occur after PPP but there is little data in the literature. The objective of this study is to evaluate factors associated with PI after PPP.

Hypothesis:

Open fractures and repacking are associated with PI after PPP.

Methods:

Consecutive patients who underwent PPP with hospital LOS > 2 days were analyzed. Demographics, duration of PPP, operative timing for pelvic fractures, and outcomes were compared between patients with and without PI. Mann Whitney U and Chi-Square tests were used for continuous and categorical variables, respectively. Patients were divided into groups of four years and significant outcomes were plotted over time.

Results:

Over a period of 16 years, 199 consecutive patients with PPP and LOS > 2 days were included; median age was 46 years (IQR 28-58), median ISS was 43 (37-57), and 18% had open fractures. Median SBP was 70mmHg with median BD of -10mmol/L. Median duration of PPP was 2 days (1-2) and 11% of patients underwent repacking. The incidence of PI was 11% (21 patients); 3 patients required hardware removal. Overall mortality was 10%. There was no difference in age, gender, mechanism of injury, fracture classification, and initial labs between patients with and without PI (all p>0.05). More patients in the PI group had an open fracture (33% vs 15%, p=0.036). Median transfusion, both pre-PPP and in 24-hours after PPP, were similar between the two groups (all p>0.05), but more patients in the PI group underwent repacking (48% vs 7%, p<0.001). Patients with PI had a longer hospital LOS (38 vs 22 days, p<0.001), longer ICU LOS (19 vs 13 days, p=0.006), and more ventilator days (16 vs 10 days, p=0.039), without a difference in mortality (p>0.05). Over the course of 16 years, the rates of PI, repacking, and mortality after PPP decreased at our institution (see Figure).

Conclusions:

In our experience the overall rate of PI after PPP is 11%, and open fracture and repacking after PPP are associated with an increased risk of PI. The rate of PI at our institution decreased over time, likely associated with a decrease in the rate of repacking.