Postoperative Infection After Tibial Fracture and Long-term Clinical Outcomes: A Propensity-Matched Cohort Study

Authors:
Lucineia Danielski

Body of Abstract:
BACKGROUND

Postoperative infection following tibial fracture fixation remains a major clinical challenge, yet its long-term consequences on bone healing, systemic complications, and survival are incompletely characterized at the population level. This study investigated the association between postoperative infection and adverse outcomes after tibial fracture.

METHODS

A retrospective cohort study was conducted using a large federated electronic health record network (2000–2025). Adult patients with tibial fractures treated operatively were classified into two cohorts: those who developed postoperative infection within 30 days of fixation and those without documented infection. Outcomes included osteomyelitis, fracture nonunion, all-cause mortality, systemic complications, sepsis, and hospital readmission, assessed at 1-, 5-, 10-, and 15-year follow-up windows starting 1 day after the index fracture. Propensity score matching (1:1) was performed to balance demographics and baseline comorbidities. Time-to-event analyses were estimated using Kaplan–Meier methods and Cox proportional hazards models.

RESULTS

Among over 45,000 eligible patients, 1,016 experienced postoperative infection. After propensity matching (n=892 per cohort), patients with infection demonstrated significantly higher long-term risks of osteomyelitis and fracture nonunion across all follow-up intervals. Infection was also associated with increased rates of systemic complications and sepsis, as well as persistently elevated hazards of all-cause mortality from 1 through 15 years of follow-up. Hospital readmissions occurred more frequently and repeatedly in the infected cohort. Survival analyses consistently showed worse outcomes among patients who developed postoperative infection, with increased hazard ratios across early and late follow-up periods.

CONCLUSIONS

Postoperative infection following tibial fracture fixation is associated with sustained long-term morbidity and mortality, including higher risks of osteomyelitis, nonunion, recurrent complications, sepsis, readmissions, and death extending up to 15 years after injury. These findings underscore the importance of aggressive infection prevention strategies and prolonged clinical surveillance in high-risk patients following tibial fracture surgery.