Pneumonia in hospitalized elderly hip fracture patients: the effects on length of hospital-stay, in-hospital and thirty-day mortality and a search for potential predictors

Salarbaks, A.M.; Lindeboom, Robert; Nijmeijer, Wieke S

doi:10.1016/j.injury.2020.05.017

Cited by 34 publications

(50 citation statements)

References 22 publications

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“…The female gender was found to be a protective factor in this population, which was different from previous studies of NI in the elderly with hip fracture [10,14,15]. However, some studies which focus on post-operative SSI and pneumonia have shown similar results [18]. Thus, these contradictory results might not be caused by gender itself but by other gender-related factors.…”

Section: Discussioncontrasting

confidence: 95%

“…In this study, gender, age range, fracture pattern, whether to operate, surgical treatment, number of comorbidities, inhospital death, and CCI all showed significant differences between the NI and control groups. In particular, patients with NI had a significantly higher in-hospital mortality than those without NI, which was consistent with previous studies [1,4,18]. This result also supported our viewpoint that considering NI as a vital and critical event is essential for supporting the elderly with hip fracture.…”

Section: Discussionsupporting

confidence: 92%

“…For the elderly with hip fracture, because of their advanced age and complex comorbidities, NI consists of infections not only at surgical sites (SSI) but also in other organs, such as pulmonary infections, urinary tract infections, and skin pressure sore infections. These infections have been proven to be associated with the increased mortality and higher hospital costs [7,[18][19][20][21][28][29][30]. Age, gender, surgical factors, and comorbidities have been investigated in association with SSIs [14,15,28,31].…”

Section: Discussionmentioning

confidence: 99%

“…The specific enumeration of comorbid conditions indicated that the most common chronic diseases consisted of a major part of the comorbidities in elderly patients with hip fracture. Additionally, chronic respiratory disease, diabetes mellitus, hypertension, and cerebrovascular disease, which were the top five most frequent, have been found to be associated with post-operative infection in both the surgical site and other organs [14,18,20,27,35,36]. Moreover, some diseases which were not in the top five most frequent, such as anemia, malignant tumour, and cardiac failure, have also have been found to be associated with post-operative infections [35,37,38].…”

Section: Discussionmentioning

confidence: 99%

“…Because of their catastrophic consequences, SSIs have drawn a large amount of attention from clinical surgeons. However, other infections, such as lung infections [18], urinary tract infections [7,19], and skin pressure ulcers [20,21], account for the majority of NIs in elderly patients after surgery. Moreover, the occurrence of NIs in organs outside of surgical sites leads to a decline in the quality of life of patients as well as increases in hospital readmission and mortality.…”

Section: Introductionmentioning

confidence: 99%

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The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity

Deng

Zheng

Cheng

et al. 2021

International Orthopaedics (SICOT)

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Purpose This is a retrospective case–control study to ascertain the factors influencing nosocomial infection (NI) in elderly patients with hip fractures. Methods A total of 80,174 patients (≥ 60 years) who suffered hip fractures between 2006 and 2017 were identified through a national inquiry of 94 hospitals. The patients were divided into an NI group and control group according to the occurrence or lack of occurrence of NI within 48 hours after surgery, respectively. Age, gender, hip fracture pattern, whether to operate, surgical treatments, and comorbidities were recorded as variables. Results A total of 9806 elderly hip fracture patients (60 years) were included, 1977 of whom were patients diagnosed with NI. The control group consisted of randomly drawn cases from the 9806 patients from different hospitals with a rate of one NI patient: four patients without NI. Patient gender, age, and in particular the number of comorbidities were associated with occurrence of NI. Using regression models to predict infection outcomes based on the number of comorbidities had an area under the curve (AUC) of 0.714, while using the Charlson comorbidity index (CCI) yielded a smaller value of 0.694. The most common comorbidities of this elderly cohort were chronic respiratory disease, hypertension, diabetes mellitus, cerebrovascular disease, and coronary heart disease. Conclusions Older age, male gender, and greater number of comorbidities were found to be associated with the occurrence of NI. In particular, the number of comorbidities was the most accurate predictor of NI occurrence, and when used to build a regression model, it had greater predictive capability than CCI to predict NI in elderly hip fracture patients. Additionally, the common diseases of the elderly should be primarily considered when investigating the relationship between comorbidities and NI in older patients.

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