Risk Factors, Clinical Outcomes, and Medical Costs of Pelvic Infection After Open Pelvic Fractures: A 7-Year Retrospective Observational Study at a Single Trauma Center.

Background/Objectives: Patients with unstable pelvic fractures typically die of hemorrhagic shock, whereas those with open pelvic fractures (OPF) more commonly die of pelvic infections (PIs) and pelvic sepsis (PS). We examined the clinical outcomes of PI in patients with OPFs. Methods: Patients with OPFs treated at our hospital between March 2016 and February 2023 were retrospectively reviewed. Factors associated with PI were identified using logistic regression analysis. Results: A total of 44 patients with OPFs were included, of whom 22 developed PIs. The number of patients with Gustilo-Anderson grade III was higher in the PI group than in the non-PI group (n = 18 vs. 8, p = 0.008). Similarly, anorectal injury was more frequent in the PI group than in the non-PI group (n = 15 vs. 3, p = 0.001). Multivariate logistic regression identified age (odds ratio 1.082 [95% confidence interval 1.020-1.148], p = 0.009), serum lactate level (1.319 [0.992-1.755], p = 0.018), presence of Gustilo-Anderson grade III (7.467 [0.987-56.517], p = 0.052), and anorectal injury (36.468 [3.107-427.991], p = 0.004) as independent risk factors for PI. Hospital length of stay, overall medical costs, and number of surgeries were 2.8 (84.0 vs. 30.5 days, p = 0.002), 2.9 (95,812 vs. 33,224 USD, p = 0.001), and 2.9 (13.0 vs. 4.5, p < 0.001) times higher in the PI group than in the non-PI group, respectively. Conclusions: Age and anorectal injury were significantly associated with pelvic infection. Serum lactate level and Gustilo-Anderson grade III injury showed possible associations, although statistical precision was limited. PIs were associated with high medical costs. Early wound management, precise antibiotic therapy, and multidisciplinary approaches are necessary to treat PIs.