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Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study

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...

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Autores principales: Gadgaard, N.R., Varnum, C., Nelissen, R.G.H.H., Vandenbroucke-Grauls, C., Sørensen, H.T., Pedersen, A.B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer London 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511604/
https://www.ncbi.nlm.nih.gov/pubmed/37330437
http://dx.doi.org/10.1007/s00198-023-06823-6
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author Gadgaard, N.R.
Varnum, C.
Nelissen, R.G.H.H.
Vandenbroucke-Grauls, C.
Sørensen, H.T.
Pedersen, A.B.
author_facet Gadgaard, N.R.
Varnum, C.
Nelissen, R.G.H.H.
Vandenbroucke-Grauls, C.
Sørensen, H.T.
Pedersen, A.B.
author_sort Gadgaard, N.R.
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00198-023-06823-6.
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spelling pubmed-105116042023-09-22 Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study Gadgaard, N.R. Varnum, C. Nelissen, R.G.H.H. Vandenbroucke-Grauls, C. Sørensen, H.T. Pedersen, A.B. Osteoporos Int Original Article 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00198-023-06823-6. Springer London 2023-06-17 2023 /pmc/articles/PMC10511604/ /pubmed/37330437 http://dx.doi.org/10.1007/s00198-023-06823-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Article
Gadgaard, N.R.
Varnum, C.
Nelissen, R.G.H.H.
Vandenbroucke-Grauls, C.
Sørensen, H.T.
Pedersen, A.B.
Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study
title Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study
title_full Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study
title_fullStr Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study
title_full_unstemmed Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study
title_short Comorbidity and risk of infection among patients with hip fracture: a Danish population-based cohort study
title_sort comorbidity and risk of infection among patients with hip fracture: a danish population-based cohort study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511604/
https://www.ncbi.nlm.nih.gov/pubmed/37330437
http://dx.doi.org/10.1007/s00198-023-06823-6
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