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 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.Orthopaedics, Trauma Surgery and Rehabilitatio

Prevention of infections with highly resistant microorganisms:Maximizing transparency by using outcome indicators

In the Netherlands the quality of health care is supervised by the Health Care Inspectorate. Since 2013 the Health Care Inspectorate has been specifically checking hospital practices for reducing transmission of highly resistant microorganisms. Its mode of operation, using process indicators, has been criticised. Here, it is proposed that this quality control be based on relevant outcome parameters of infection prevention strategies. This would also maximise transparency regarding the occurrence of infections caused by highly resistant microorganisms in Dutch hospitals.</p

Prevention of infections with highly resistant microorganisms:Maximizing transparency by using outcome indicators

In the Netherlands the quality of health care is supervised by the Health Care Inspectorate. Since 2013 the Health Care Inspectorate has been specifically checking hospital practices for reducing transmission of highly resistant microorganisms. Its mode of operation, using process indicators, has been criticised. Here, it is proposed that this quality control be based on relevant outcome parameters of infection prevention strategies. This would also maximise transparency regarding the occurrence of infections caused by highly resistant microorganisms in Dutch hospitals.</p

Prevention of infections with highly resistant microorganisms:Maximizing transparency by using outcome indicators

In the Netherlands the quality of health care is supervised by the Health Care Inspectorate. Since 2013 the Health Care Inspectorate has been specifically checking hospital practices for reducing transmission of highly resistant microorganisms. Its mode of operation, using process indicators, has been criticised. Here, it is proposed that this quality control be based on relevant outcome parameters of infection prevention strategies. This would also maximise transparency regarding the occurrence of infections caused by highly resistant microorganisms in Dutch hospitals.</p