Postoperative infection post-fracture linked to substantially reduced future household income

1. Postoperative infection in patients with surgically treated fractures is associated with significantly decreased patient household income

Evidence Rating Level: 2 (Good)

Study Rundown: Approximately 6.3 million fractures occur in the U.S alone each year. Postoperative infection remains one of the most common and costly complications of operative treatment for fractures. In this retrospective cohort study, the annual household income data of patients in Maryland (up to 6 years after injury) was collected to examine the relationship between earning potentials after fracture and occurrence of postoperative infection within the first six years of surgical treatment for the fracture. Developing postoperative infections was associated with substantial and sustained household income reduction in the 6 years after the injury. However, postoperative infections were not associated with increased Social Security benefits received. One strength of this study was utilizing a large sample size with various fracture injury types and patients with different income levels. By studying patient incomes up to 6 years after the injury, the long-term reduction in wages and impact on patient lives were thoroughly characterized. One limitation of the study, however, is that patients with fractures are retrospectively identified with Current Procedural Terminology (medical billing) codes, which could lead to misclassifications. Data on preinjury occupations were also lacking.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge

In-Depth [retrospective cohort study]: In this retrospective cohort study, postoperative infections were shown to be linked with a $6080 reduction in annual household income in the 6 years after injury (95%CI, P = .048). Postoperative infections were associated with 6.6% increase (95%CI, 4.9%-8.3%; P < .001) in the risk of catastrophic wage loss following the first two years of the fracture. Notably, patients who developed postoperative infections did not received an associated increase in Social Security Benefits, suggesting that the current social infrastructures and mechanisms in place are not sufficient to compensate for the detrimental impacts of fractures and the associated complications thereafter.

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