75,000 Patient Study Details Hip Fracture Infection Risk

Using data from nearly 75,000 hip fractures, Danish researchers tackled the issue of postop infection and antibiotic use after discharge following hip surgery.

The study, “Increasing Risk of Hospital‐Treated Infections and Community‐Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016,” appears in the December 4, 2018 edition of the Journal of Bone and Mineral Research.

Co-author Kaja Kjørholt, M.S., B.Med.Sc., with the department of Clinical Epidemiology at Aarhus University Hospital in Denmark, explained the study to OTW,“Some previous studies report infections to be among the leading causes of death after hip fracture surgery. We therefore found it very important to evaluate the risk of postoperative infections and assess changes over time in order to contribute to a better understanding of the quality of treatment, care and rehabilitation after hip fracture surgery.”

“To our knowledge, no other studies have previously examined the change in risk of hospital-treated infections after hip fracture surgery over time in population-based settings; neither had they looked at antibiotics use after discharge from the hospital.”

“Using individual-level data from Danish population-based registries, we identified 74,771 hip fracture patients aged 65 years or older with first-time hip fracture surgery from 2005-2016. The risk of hospital-treated infections and community-based antibiotic use (at 15 days, 30 days, 180 days and 365 days follow-up) increased during 2005-2016.”

“The incidence of all hospital-treated infections within 30 days after hip fracture surgery increased by 32%, from 10.8% in 2005-2006 to 14.3% in 2015-2016. The risk of hospital-treated pneumonia within 30 days increased by 70% in 2015-2016 compared to 2005-2006.”

“Community-based antibiotic prescriptions within 30 days increased by 54%, from 17.5% in 2005-2006 to 27.1% in 2015-2016, and especially the use of broad-spectrum antibiotics increased, and increased by 79% over the study period. We compared the trends among hip fracture patients to the general population, and the results cannot entirely be explained by a similar increase in the general population.”

“This work indicates that there is a clinical need to target preventive treatment in order to hopefully reduce the risk of infections in hip fracture patients. Given the high mortality following infections in elderly individuals, future research and clinical work should focus on improving our understanding of the risk factors and patient profiles associated with postoperative infections.”

“Knowledge of risk factors that can potentially be modified during the pre-, per-, and postoperative periods may be useful for identifying patients and preventive attack points for interventions targeting specific infection types, thus enabling cost-effective preventive measures and treatment protocols to reduce infections and mortality.”

“Orthopaedic surgeons do not necessarily see infected patients because patients are admitted at the medical or geriatric department. One out of 10 and three out of 10 hip fracture patients die within 30 days and one year, respectively. In order to improve prognosis of hip fracture patients and reduce their high mortality, a multidisciplinary approach against infections, both pre-, per and postoperatively should be even more in focus as it is now.”