Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016
Eva N Glassou,1,2 Kaja KE Kjørholt,3 Torben B Hansen,1 Alma B Pedersen31University clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Aarhus University, Holstebro 7500, Denmark; 2Department of Quality, Regional Hospital West Jutland, Holstebro 7500, Denmark; 3Departmen...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2019-05-01
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| Series: | Clinical Epidemiology |
| Subjects: | |
| Online Access: | https://www.dovepress.com/delay-in-surgery-risk-of-hospital-treated-infections-and-the-prognosti-peer-reviewed-article-CLEP |
| _version_ | 1818082714217086976 |
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| author | Glassou EN Kjørholt KKE Hansen TB Pedersen AB |
| author_facet | Glassou EN Kjørholt KKE Hansen TB Pedersen AB |
| author_sort | Glassou EN |
| collection | DOAJ |
| description | Eva N Glassou,1,2 Kaja KE Kjørholt,3 Torben B Hansen,1 Alma B Pedersen31University clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Aarhus University, Holstebro 7500, Denmark; 2Department of Quality, Regional Hospital West Jutland, Holstebro 7500, Denmark; 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N 8200, DenmarkPurpose: We examined the association between delay in surgery and hospital-treated infections in hip fracture patients with and without known comorbidities.Patients and methods: All hip fracture patients aged ≥65 years registered in the Danish Multidisciplinary Hip Fracture Registry from 2005 to 2016 were included (n=72,520). Delay in surgery was defined as the time in hours from admission to surgery and was divided into 3 groups (12, 24 and 48 hrs). The outcomes were hospital-treated pneumonia, urinary tract infection and reoperation due to infection 0–30 days after surgery. As a measure of comorbidity, we used the Charlson Comorbidity Index (CCI): none (no registered comorbidities prior to the fracture), medium (1–2 points) and high (≥3 points).Results: Overall, there was an association between a delay of 12 hrs and pneumonia. A delay of 12 hrs was associated with an increased risk of pneumonia in patients with no comorbidities (adjusted hazard ratio (HR) 1.20, confidence interval (CI) 1.03–1.40) and a delay of 24 hrs was associated with an increased risk of pneumonia in patients with a medium level of comorbidity (HR 1.12, CI (1.02–1.23)). Overall, delay was associated with reoperation due to infection, particularly among patients with comorbidities, although the confidence intervals of some of the estimates were wide. A delay of 48 hrs was associated with an increased risk of reoperation due to infection in patients with a high level of comorbidity (HR 2.36, CI 1.19–4.69).Conclusion: Delay in surgery was associated with an increased risk of hospital-treated pneumonia and reoperations due to infection within 30 days of surgery. The number of postoperative hospital-treated infections within 30 days may be reduced by continuously targeting pre-, per- and postoperative optimization not only for patients with high level of comorbidity but also for hip fracture patients without known comorbidities prior to surgery.Keywords: hip fracture, delay in surgery, pneumonia, urinary tract infection, reoperation, surgical site infection |
| first_indexed | 2024-12-10T19:26:29Z |
| format | Article |
| id | doaj.art-fb706d1d8f2942489a6fd266dbeb963b |
| institution | Directory Open Access Journal |
| issn | 1179-1349 |
| language | English |
| last_indexed | 2024-12-10T19:26:29Z |
| publishDate | 2019-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Epidemiology |
| spelling | doaj.art-fb706d1d8f2942489a6fd266dbeb963b2022-12-22T01:36:22ZengDove Medical PressClinical Epidemiology1179-13492019-05-01Volume 1138339545743Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016Glassou ENKjørholt KKEHansen TBPedersen ABEva N Glassou,1,2 Kaja KE Kjørholt,3 Torben B Hansen,1 Alma B Pedersen31University clinic for hand, hip and knee surgery, Regional Hospital West Jutland, Aarhus University, Holstebro 7500, Denmark; 2Department of Quality, Regional Hospital West Jutland, Holstebro 7500, Denmark; 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N 8200, DenmarkPurpose: We examined the association between delay in surgery and hospital-treated infections in hip fracture patients with and without known comorbidities.Patients and methods: All hip fracture patients aged ≥65 years registered in the Danish Multidisciplinary Hip Fracture Registry from 2005 to 2016 were included (n=72,520). Delay in surgery was defined as the time in hours from admission to surgery and was divided into 3 groups (12, 24 and 48 hrs). The outcomes were hospital-treated pneumonia, urinary tract infection and reoperation due to infection 0–30 days after surgery. As a measure of comorbidity, we used the Charlson Comorbidity Index (CCI): none (no registered comorbidities prior to the fracture), medium (1–2 points) and high (≥3 points).Results: Overall, there was an association between a delay of 12 hrs and pneumonia. A delay of 12 hrs was associated with an increased risk of pneumonia in patients with no comorbidities (adjusted hazard ratio (HR) 1.20, confidence interval (CI) 1.03–1.40) and a delay of 24 hrs was associated with an increased risk of pneumonia in patients with a medium level of comorbidity (HR 1.12, CI (1.02–1.23)). Overall, delay was associated with reoperation due to infection, particularly among patients with comorbidities, although the confidence intervals of some of the estimates were wide. A delay of 48 hrs was associated with an increased risk of reoperation due to infection in patients with a high level of comorbidity (HR 2.36, CI 1.19–4.69).Conclusion: Delay in surgery was associated with an increased risk of hospital-treated pneumonia and reoperations due to infection within 30 days of surgery. The number of postoperative hospital-treated infections within 30 days may be reduced by continuously targeting pre-, per- and postoperative optimization not only for patients with high level of comorbidity but also for hip fracture patients without known comorbidities prior to surgery.Keywords: hip fracture, delay in surgery, pneumonia, urinary tract infection, reoperation, surgical site infectionhttps://www.dovepress.com/delay-in-surgery-risk-of-hospital-treated-infections-and-the-prognosti-peer-reviewed-article-CLEPHip fracturedelay in surgerypneumoniaurinary tract infectionreoperationsurgical site infection |
| spellingShingle | Glassou EN Kjørholt KKE Hansen TB Pedersen AB Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016 Clinical Epidemiology Hip fracture delay in surgery pneumonia urinary tract infection reoperation surgical site infection |
| title | Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016 |
| title_full | Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016 |
| title_fullStr | Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016 |
| title_full_unstemmed | Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016 |
| title_short | Delay in surgery, risk of hospital-treated infections and the prognostic impact of comorbidity in hip fracture patients. A Danish nationwide cohort study, 2005–2016 |
| title_sort | delay in surgery risk of hospital treated infections and the prognostic impact of comorbidity in hip fracture patients a danish nationwide cohort study 2005 ndash 2016 |
| topic | Hip fracture delay in surgery pneumonia urinary tract infection reoperation surgical site infection |
| url | https://www.dovepress.com/delay-in-surgery-risk-of-hospital-treated-infections-and-the-prognosti-peer-reviewed-article-CLEP |
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