Background Surgical site infections (SSIs) following neck of femur fracture surgery are associated with increased morbidity, mortality, and healthcare costs. Identifying risk factors for SSIs is essential for improving patient outcomes. Methods This is a prospective cohort study in Morriston Hospital, Swansea, analysing neck of femur fracture surgeries between 2019 and 2024. Data were collected on ASA grade, Abbreviated Mental Test (AMT) score, duration of operation, time to theatre, closure type, grade of surgeon, and operation type. Statistical analysis was performed using univariate (chi-square, Mann-Whitney U) and multivariate logistic regression analyses. Results 1,737 cases were included. The overall, SSI rate was 4.3%, falling from 9.43% in 2019 to 1.93% in 2024. Closure type influenced infection rates, with a reduction in SSI following the transition from clips (88.3% in 2019 to 5.8% in 2024) to Monocryl (11.3% to 93.3%). On univariate analysis, significant associations were found between SSI incidence and closure type (p = 0.022), time to theatre (p < 0.0001), and operative duration (p < 0.0001). On multivariate analysis, higher AMT scores were found to be protective against infection (p < 0.0001 for AMT 8, p = 0.023 for AMT 9). Additionally, hemiarthroplasty and intramedullary nailing were associated with a lower rate of infection, both with p < 0.0001. Conclusion Findings suggest that closure type plays a role in SSI risk in neck of femur fracture surgery. Further prospective studies are needed to validate these findings and explore additional risk factors. This study contributes to optimising surgical techniques and improving patient outcomes.
Solari et al. (2025) studied this question.