Sepsis and rectal injuries in patients with pelvic fractures at a level 1 trauma center: a retrospective cohort study

Abstract

Background

Sepsis is a cause of delayed morbidity and mortality after pelvic fracture surgery. Rectal injuries, although rare, may be underdiagnosed and contribute to infectious complications. Recent studies on this topic are scarce and often lack radiologic correlation. This study aimed to address the following questions: (1) What is the incidence of sepsis in surgically treated pelvic and/or acetabular fractures? (2) Which clinical and injury-related factors are associated with sepsis? (3) Are rectal injuries underdiagnosed? and (4) Do radiologic perirectal abnormalities correlate with sepsis?

Hypothesis

We hypothesized that sepsis is associated with identifiable clinical risk factors and that radiologic signs of rectal injury are underrecognized contributors to sepsis.

Patients and methods

In this retrospective cohort study, we included 1059 patients who underwent pelvic or acetabular fracture surgery at a Level 1 Trauma Center between 2009 and 2020. Clinical data and CT imaging were reviewed. Patients were stratified by sepsis status. Sepsis was defined according to the Sepsis-3 criteria. The primary outcome was occurrence of sepsis; secondary outcomes included ICU stay, length of hospitalization, and 90-day mortality. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for sepsis.

Results

Sepsis occurred in 71 patients (7%). In multivariate analysis, an Injury Severity Score ≥20 (OR 2.88, 95% CI 1.36–6.07), emergency laparotomy (OR 6.70, 95% CI 2.84–15.78), heart disease (OR 4.80, 95% CI 1.82–12.69), and liver disease (OR 3.67, 95% CI 1.11–12.08) were independently associated with sepsis. Rectal injury was diagnosed in 1 patient (0.1%), while perirectal CT abnormalities were observed in 107/766 (14%) patients. Sepsis was associated with longer ICU stays, longer hospitalization, and increased 90-day mortality.

Discussion

The incidence of sepsis remains clinically significant in pelvic fracture patients and is associated with identifiable injury and patient-related factors. Radiologic perirectal findings are more frequent than clinically diagnosed rectal injuries and may signal occult injury. These findings suggest a need for heightened vigilance and further investigation of subtle imaging abnormalities.

Level of evidence

IV; retrospective cohort study.