Postoperative Infection and Acute Pre-injury Alcohol Use Disorder in Hip Fracture Trauma Patients

Authors:
Jeffrey Liang, Newton Cao, Ashar Ata, Vishal Senthilkumar, Mitchell Rheeman, Marcel Tafen, Kurt Edwards, Amy Howk, Stephen Martone, Andrew Deroo, Samantha Thomas, Kinga Powers, Brian Nasca

Body of Abstract:
Background:
Alcohol use disorder (AUD) is common among trauma patients and is associated with immune dysregulation and poor wound healing. The independent contribution of AUD to infectious complications after hip fracture surgery is not well characterized. We hypothesize that acute pre-injury alcohol use disorder (AAUD) increases the risk of postoperative infection(POI). This study aims to evaluate the association between AAUD and POI following hip fracture repair following trauma.

Methods:
We conducted a retrospective cohort study of trauma patients using the 2023 TQIP database. AAUD was defined by a documented AUD history and a positive blood alcohol level higher ≥ 0.08. POI was defined as any infection occurring during hospitalization, including deep SSI, organ-space SSI, osteomyelitis, sepsis, and pneumonia. Bivariate analyses and logistic regression assessed associations between AAUD and infection, adjusting for age, sex, race, insurance, and injury severity score (ISS). Hospital-level factors, including trauma center level, and teaching status were evaluated.

Results:
A total of 122,876 patients were included. Of that, 7,290(5.9%) patients fit the AAUD criteria.

Patients in the AAUD group were younger (mean age 64 vs 72 years) and were more frequently male (63% vs 35%). They were more likely to have public insurance (25% vs 15%), a higher ISS (11.6 vs 10.0). The AAUD cohort demonstrated markedly greater rates of smoking, cirrhosis, COPD, and composite mental illness, whereas the non-AAUD group had higher rates of diabetes, congestive heart failure, dementia, and hypertension (all p < 0.001). Overall POI occurred in 0.41% of patients and was significantly higher among those with AAUD (0.93% vs 0.38%; p < 0.001), younger age 18–30 (1.56% vs ≥70: ~0.30%; p < 0.001), male sex (0.61% vs 0.29%; p < 0.001), non-White race (Black: 0.96% vs White: 0.35%; p < 0.001), public insurance (0.66% vs 0.34%; p < 0.001), and higher ISS (18.0 vs 10.1; p < 0.001). AAUD patients also had increased respiratory complications (0.15% vs 0.08%), DVT (0.80% vs 0.46%), intubation (1.29% vs 0.72%), unplanned OR (1.06% vs 0.37%), alcohol withdrawal (5.34% vs 0.06%), ICU admission (17.9% vs 10.6%), and longer hospital stay (9.13 vs 7.41 days). In unadjusted analysis, AAUD was associated with significantly higher odds of post-operative infection (OR 2.50; 95% CI 1.93–3.23; p < 0.001). After adjusting for ISS, age, sex, race, and insurance, AAUD remained an independent predictor (OR 1.50, 95% CI 1.14–1.97, p = 0.003). Higher ISS, male sex, and Black or Asian race also independently increased infection risk. Conclusions: In this TQIP cohort of hip fractures, AAUD was independently associated with POI. Male sex, higher ISS, and Black or Asian race also increased infection risk, highlighting the need for targeted risk mitigation in these populations.