TY - JOUR
T1 - Comorbidity and risk of infection among patients with hip fracture
T2 - a Danish population-based cohort study
AU - Gadgaard, N. R.
AU - Varnum, C.
AU - Nelissen, R. G. H. H.
AU - Vandenbroucke-Grauls, C.
AU - Sørensen, H. T.
AU - Pedersen, A. B.
N1 - Funding Information: Open access funding provided by Royal Danish Library, Aarhus University Library This study was supported by Helsefonden (Grant number 20-B-0140) and the Department of Clinical Medicine at Aarhus University, Denmark. The funders had no influence on collection of data, design of the study, analysis, interpretation or reporting of results, or the submission for publication. Publisher Copyright: © 2023, The Author(s).
PY - 2023/10
Y1 - 2023/10
N2 - Summary: Impact of comorbidity on infection risk among hip fracture patients is unclear. We found high incidence of infection. Comorbidity was an important risk factor for infection up to 1 year after surgery. Results indicates a need for additional investment in pre- and postoperative programs that assist patients with high comorbidity. Purpose: Comorbidity level and incidence of infection have increased among older patients with hip fracture. The impact of comorbidity on infection risk is unclear. We conducted a cohort study examining the absolute and relative risks of infection in relation to comorbidity level among hip fracture patients. Methods: Utilizing Danish population-based medical registries, we identified 92,600 patients aged ≥ 65 years undergoing hip fracture surgery between 2004 and 2018. Comorbidity was categorized by Charlson comorbidity index scores (CCI): none (CCI = 0), moderate (CCI = 1–2), or severe (CCI ≥ 3). Primary outcome was any hospital-treated infection. Secondary outcomes were hospital-treated pneumonia, urinary tract infection, sepsis, reoperation due to surgical-site infection (SSI), and a composite of any hospital- or community-treated infection. We calculated cumulative incidence and hazard ratios (aHRs) adjusted for age, sex, and surgery year, including 95% confidence intervals (CIs). Results: Prevalence of moderate and severe comorbidity was 40% and 19%, respectively. Incidence of any hospital-treated infection increased with comorbidity level within 0–30 days (none 13% vs. severe 20%) and 0–365 days (none 22% vs. 37% severe). Patients with moderate and severe comorbidity, compared to no comorbidity, had aHRs of 1.3 (CI: 1.3–1.4) and 1.6 (CI: 1.5–1.7) within 0–30 days, and 1.4 (CI: 1.4–1.5) and 1.9 (CI: 1.9–2.0) within 0–365, respectively. Highest incidence was observed for any hospital- or community-treated infection (severe 72%) within 0–365 days. Highest aHR was observed for sepsis within 0–365 days (severe vs. none: 2.7 (CI: 2.4–2.9)). Conclusion: Comorbidity is an important risk factor for infection up to 1 year after hip fracture surgery.
AB - Summary: Impact of comorbidity on infection risk among hip fracture patients is unclear. We found high incidence of infection. Comorbidity was an important risk factor for infection up to 1 year after surgery. Results indicates a need for additional investment in pre- and postoperative programs that assist patients with high comorbidity. Purpose: Comorbidity level and incidence of infection have increased among older patients with hip fracture. The impact of comorbidity on infection risk is unclear. We conducted a cohort study examining the absolute and relative risks of infection in relation to comorbidity level among hip fracture patients. Methods: Utilizing Danish population-based medical registries, we identified 92,600 patients aged ≥ 65 years undergoing hip fracture surgery between 2004 and 2018. Comorbidity was categorized by Charlson comorbidity index scores (CCI): none (CCI = 0), moderate (CCI = 1–2), or severe (CCI ≥ 3). Primary outcome was any hospital-treated infection. Secondary outcomes were hospital-treated pneumonia, urinary tract infection, sepsis, reoperation due to surgical-site infection (SSI), and a composite of any hospital- or community-treated infection. We calculated cumulative incidence and hazard ratios (aHRs) adjusted for age, sex, and surgery year, including 95% confidence intervals (CIs). Results: Prevalence of moderate and severe comorbidity was 40% and 19%, respectively. Incidence of any hospital-treated infection increased with comorbidity level within 0–30 days (none 13% vs. severe 20%) and 0–365 days (none 22% vs. 37% severe). Patients with moderate and severe comorbidity, compared to no comorbidity, had aHRs of 1.3 (CI: 1.3–1.4) and 1.6 (CI: 1.5–1.7) within 0–30 days, and 1.4 (CI: 1.4–1.5) and 1.9 (CI: 1.9–2.0) within 0–365, respectively. Highest incidence was observed for any hospital- or community-treated infection (severe 72%) within 0–365 days. Highest aHR was observed for sepsis within 0–365 days (severe vs. none: 2.7 (CI: 2.4–2.9)). Conclusion: Comorbidity is an important risk factor for infection up to 1 year after hip fracture surgery.
KW - Cohort
KW - Comorbidity
KW - Epidemiology
KW - Hip fracture
KW - Infections
UR - http://www.scopus.com/inward/record.url?scp=85162012614&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00198-023-06823-6
DO - https://doi.org/10.1007/s00198-023-06823-6
M3 - Article
C2 - 37330437
SN - 0937-941X
VL - 34
SP - 1739
EP - 1749
JO - Osteoporosis international
JF - Osteoporosis international
IS - 10
ER -