Kaja Eriksrud Kjørholt1, Nickolaj Risbo Kristensen2, Daniel Prieto-Alhambra3, Søren Paaske Johnsen4, Alma Bečić Pedersen2. 1. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. Electronic address: kaja.eriksrud.kjoerholt@gmail.com. 2. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. 3. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Old Rd, Oxford OX3 7LD, United Kingdom. 4. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Mølleparkvej 10, 9000 Aalborg, Denmark.
Abstract
BACKGROUND: Postoperative infection is a common complication in hip fracture patients and the risk appears to have increased during the last decade. However, the impact of infection on mortality after hip fracture surgery remains unclear. PURPOSE: We aimed to examine the association between infection (any, as well as specific infections), with all-cause mortality following hip fracture surgery. METHODS: Using Danish nationwide registries, we conducted a population-based cohort study on 74,771 hip fracture patients ≥65 years old operated from 2005 to 2016. We included hospital-treated infection as a time-varying exposure, and calculated 30-days mortality rate per 1000 person-years (PY). We used time-varying Cox Proportional Hazard Regression to compute 30-days adjusted hazards ratios (aHRs) with 95% confidence interval (CI) comparing the mortality of hip fracture patients with and without infections. We adjusted for sex, age, comorbidities, medication use, and marital status. RESULTS: Within 30 days of surgery, 9592 (12.8%) patients developed a hospital-treated infection. Among these, 30-days mortality was 8.43 per 1000 PY compared with 3.34 among patients without infection (aHR = 2.72, 95% CI: 2.56-2.88). For patients who developed pneumonia, aHR was 4.18 (95% CI: 3.91-4.48), whereas the aHR was 8.86 (95% CI: 7.88-9.95) for patients who developed systemic sepsis. For patients who sustained reoperation due to infection, aHR was 2.95 (95%CI: 1.88-4.64). The mortality was higher in infected vs. non-infected patients irrespective of patients' age, sex and comorbidity. CONCLUSION: Infection within 30 days of hip fracture surgery is associated with substantially increased mortality risk. Further research should improve our knowledge about patients at increased risk and prevention measures for specific infections.
BACKGROUND:Postoperative infection is a common complication in hip fracturepatients and the risk appears to have increased during the last decade. However, the impact of infection on mortality after hip fracture surgery remains unclear. PURPOSE: We aimed to examine the association between infection (any, as well as specific infections), with all-cause mortality following hip fracture surgery. METHODS: Using Danish nationwide registries, we conducted a population-based cohort study on 74,771 hip fracturepatients ≥65 years old operated from 2005 to 2016. We included hospital-treated infection as a time-varying exposure, and calculated 30-days mortality rate per 1000 person-years (PY). We used time-varying Cox Proportional Hazard Regression to compute 30-days adjusted hazards ratios (aHRs) with 95% confidence interval (CI) comparing the mortality of hip fracturepatients with and without infections. We adjusted for sex, age, comorbidities, medication use, and marital status. RESULTS: Within 30 days of surgery, 9592 (12.8%) patients developed a hospital-treated infection. Among these, 30-days mortality was 8.43 per 1000 PY compared with 3.34 among patients without infection (aHR = 2.72, 95% CI: 2.56-2.88). For patients who developed pneumonia, aHR was 4.18 (95% CI: 3.91-4.48), whereas the aHR was 8.86 (95% CI: 7.88-9.95) for patients who developed systemic sepsis. For patients who sustained reoperation due to infection, aHR was 2.95 (95%CI: 1.88-4.64). The mortality was higher in infected vs. non-infectedpatients irrespective of patients' age, sex and comorbidity. CONCLUSION:Infection within 30 days of hip fracture surgery is associated with substantially increased mortality risk. Further research should improve our knowledge about patients at increased risk and prevention measures for specific infections.
Authors: Viviane Cristina Uliana Peterle; Maria Rita Carvalho Garbi Novaes; Paulo Emiliano Bezerra Junior; João Carlos Geber Júnior; Rodrigo Tinôco Magalhães Cavalcante; Jurandi Barrozo da Silva Junior; Ray Costa Portela; Ana Patricia de Paula Journal: PLoS One Date: 2022-08-12 Impact factor: 3.752