Dr. Jocelyn Wittstein

I mean...

almost every time you get called by the emergency room for hip fracture, it's like in the middle of the night.

I should actually look and see if there's a delay in this, but I think most of the fractures happen at night.

And, and it's so often the story.

Getting up, tripping, falling.

And then, so there's, there are patients that are diagnosed with the urinary tract infection preoperatively, but you're not going to like, you can't delay surgery because outcomes are worse.

Survival is worse if you delay more than a day or two.

And so you've got these people who either have the infection pre-op or develop it post-op.

And it delays, you know, they're in the hospital for longer.

Women who have a urinary tract infection diagnosed at the time of hip fracture have like four times the rate of septic shock post-operatively as compared to those who weren't diagnosed with the pre-op.

I actually think many of them are underdiagnosed pre-op.

So I think it contributes to the falling, contributes to the urosepsis after, probably, you know, contributes to...

to death.

And we know that vaginal estrogen prevents urinary tract infections.

50%.

Yeah, prevents a lot of them.

And so if we could reduce those, I swear we would reduce hip fractures and we would definitely reduce urosepsis.

It's not like you can just give someone vaginal estrogen right after hip fracture surgery and expect them to have less UTIs because it takes six weeks or so to be effective.

To grow back.

To change the microbiome.