Increased risk of mortality after postoperative infection in hip fracture patients

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 2005-2016. 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, 9,592 (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. noninfected 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.

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

“…[6][7][8] It not only leads to more hospital stay, poor functional outcomes, and greater costs but also results in a substantially increased mortality risk. 9,10 A variety of risk factors of SSI were documented, including age, comorbidities, obesity, the experience of the surgeon, haematoma, surgical duration, increased duration of anaesthesia, body mass index (BMI), current smoking, preoperative hospital stay, serum albumin, warfarin treatment, and so forth. 6,11,12 As reported by Harrison, 13 the method of fracture fixation was also significantly associated with the SSI.…”

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

“…13 Several studies identify postoperative pneumonia as a predictor of short-term and long-term mortality after surgery. [14][15][16][17][18][19] Is there a difference in the outcomes of postoperative pneumonia between patients with and without T2DM?…”

<p>The Danish Multidisciplinary Hip Fracture Registry 13-Year Results from a Population-Based Cohort of Hip Fracture Patients</p>

“…[29][30][31] In addition, associations between transfusion practice and outcome, 32,33 association between surgery delay and post-operative complications, 34,35 associations between some commonly used medication preoperatively, including antidepressants, anticoagulants and anti-inflammatory drugs and post-operative complications [36][37][38][39][40] have been observed. Moreover, studies have found that about 15% of hip fracture patients develop an acute kidney injury within 5 days of surgery 41,42 and about 15% of patients sustain postoperative infections within 30 days of surgery, 43,44 complications which are strongly associated with 30 days mortality. Besides, hip fracture patients were at increased excess risk of venous thromboembolism, myocardial infarction and stroke up to one year following fracture.…”