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Joint Diseases and
Related Surgery
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Original Article · Open access

Risk factors for persistent wound drainage after hemiarthroplasty in elderly hip fracture patients

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Zekeriya Ersin Çelen

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0001-5229-0802

Ali Utkan

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0002-3653-3998

Cem Cüneyt Köse

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0002-3489-6568

Olgun Bingöl

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0003-1720-1709

Bülent Özkurt

Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye

ORCID: 0000-0002-6135-1870

Abstract

Objectives: This study aims to evaluate the risk factors for persistent wound drainage (PWD) and its impact on in-hospital outcomes among geriatric patients with hip fractures treated with hemiarthroplasty.

Patients and methods: A total of 265 hip fracture patients (91 males, 174 females; median age: 83 years; range, 65 to 99 years) who underwent hip hemiarthroplasty between June 2019 and June 2025 were retrospectively analyzed. Demographics, comorbidities, laboratory findings, and preoperative medications were evaluated. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of PWD.

Results: Sixty-one (23.0%) patients were diagnosed with PWD. Low postoperative Day 1 serum albumin level (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.79-0.92, p < 0.001), preexisting hypertension (OR = 2.50, 95% CI 1.15-5.39, p = 0.020), and chronic warfarin use (OR = 8.15, 95% CI 2.20-30.14, p = 0.002) were identified as independent predictors of PWD. The optimal cut-off for the postoperative Day 1 serum albumin level was 30.5 g/L (sensitivity: 60.7%, specificity: 76.5%). In the PWD group, in-hospital mortality rates (16.4% vs. 5.9%, p = 0.009), mean length of hospital stay (17.7 ± 11.8 days vs. 7.4 ± 6.3 days, p = 0.000), and the incidence of sacral decubitus ulcers (26.2% vs. 10.8%, p = 0.003) were significantly higher. Rates of both superficial and deep wound infections were also significantly elevated in the PWD group (p < 0.001 and p = 0.003, respectively).

Conclusion: Low postoperative albumin, preexisting hypertension, and chronic warfarin use are significant predictors of PWD following hemiarthroplasty in elderly patients with hip fractures, and the existence of PWD was associated with increased in-hospital morbidity and mortality. Early identification and preventive strategies targeting at-risk patients may improve outcomes.

Declarations

Author Contributions

Participated in data collection, analysis, writing original draft, creating figures: Z.E.Ç.; Contributed to manuscript review and editing, creating figures, supervision: A.U.; Conducted material preparation, data collection: C.C.K.; Contributed to manuscript review and editing: O.B.; Contributed to study conception, manscript review and editing: B.Ö. All authors read and approved the final manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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