Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study

Introduction The National Institute of Health and Care Excellence recommends that people with hip fracture should have surgery on the day of, or the day after, admission. However, there remains unacceptable variation in performance around the country, with a range of 13-91% of patients meeting this target. Dedicated trauma lists have insufficient capacity in many hospitals. We occasionally employ a mixed-use emergency theatre to facilitate early surgery. Increased risk of infection has been raised as a concern owing to microbial surface contamination from a preceding unclean case and lack of laminar flow in these theatres. The objective of this study was to investigate whether there is an increased risk of surgical site infections in patients who had hip fracture surgery in a mixed-use emergency theatre. Methods Between August 2010 and July 2014, 74 patients had hip fracture surgery in a mixed-use emergency theatre without laminar flow. This group was compared with a control group of patients who had hip fracture surgery in dedicated orthopaedic theatres with laminar flow. Infection was the primary outcome measured. Results There was no statistically significant difference in the rate of infection, length of stay or 30-day mortality, readmission or reoperation rates between the two groups. Conclusions Operating on hip fractures in mixed-use theatre did not lead to an increase in infection or other complications in our series. We feel that the risk of infection can be balanced against advantages of timely operation and it may therefore be justified to use these theatres when faced with lack of time on the trauma list. A much larger series would be required to investigate the effects of confounders.