Surgical Site Infections in Elderly Fragility Hip Fractures Patients Undergoing Warfarin Treatment

Tal Frenkel Rutenberg*, Maria Vitenberg, Dafna Yahav, Galia Spectre, Steven Velkes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives:Surgical site infection (SSI) is a devastating complication of proximal femoral fracture surgery, related with an increased morbidity and mortality. As warfarin treatment has been described as a risk factor for SSI, we aimed to compare patient and SSI characteristics in warfarin and nonanticoagulated patients.Design:Retrospective cohort study.Setting:Level-1 trauma center.Patients:Individuals 65 years of age and older with fragility hip fractures.Intervention:Patients were divided into 2 cohorts: warfarin treated (n = 85) or nonanticoagulated (n = 771). Demographics, in-hospital characteristics, laboratory data, prior hospitalizations, recent antibiotic use, and 1-year incidence of SSIs and their characteristics were gathered.Main Outcome Measures:Postoperative SSIs.Results:Twelve patients (14.1%) from the warfarin group and 21 patients (2.7%) from the noncoagulated group had SSI (P < 0.001). Both groups were comparable in terms of demographics and Charlson comorbidity score. Warfarin-treated patients had reduced white blood and neutrophils counts (10.1 ± 3.2 vs. 11.6 ± 4.0 cells/mm3 and 8.1 ± 3.2 vs. 9.6 ± 3.9 cells/mm3 for both comparisons respectively; P < 0.001 for both). They were more likely to be admitted to a geriatric ward than to orthopedics ward and were delayed to theater (58.5 ± 44.5 vs. 30.6 ± 27.4 hours; P < 0.001). Following surgery, there was no difference in blood transfusions required, in-hospital complications, or time to infection. Rates of prior hospitalizations, antibiotic use, or type of bacteria did not differ.Conclusions:Warfarin treatment in fragility hip fracture surgery is correlated with an increased risk for SSI, regardless of in-hospital complications, and hospitalizations before surgery or to the infection itself.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)518-524
Number of pages7
JournalJournal of Orthopaedic Trauma
Issue number10
StatePublished - 1 Oct 2019


  • anticoagulation
  • fragility fracture
  • proximal femoral fracture
  • surgical site infection
  • warfarin


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