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 We conducted a prospective cohort study at Morriston Hospital, Swansea, United Kingdom, analysing neck of femur fracture surgeries performed between 2019 and 2024. Data were collected on ASA (American Society of Anesthesiologists) grade, Abbreviated Mental Test (AMT) score, duration of operation, time to theatre, skin closure method, grade of surgeon, and operation type. Statistical analysis was performed using univariate (Chi-squared and Mann-Whitney U) and multivariate logistic regression analyses. Results A total of 1,737 cases were included. The overall SSI rate was 4.3%, with a reduction from 9.43% in 2019 to 1.93% in 2024. Skin closure method influenced infection rates, with a notable reduction in SSIs 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 method (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, and p = 0.023 for AMT 9). Additionally, hemiarthroplasty and intramedullary nailing were protective against infection, both with p < 0.0001. Conclusion Findings suggest that the skin closure method plays a role in SSI risk following 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.
Keywords: deep incisional ssi; neck of femur fracture (nof); neck of femur fractures; superficial ssi; surgical site infection (ssi).
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