ASSOCIATION OF AGE AND INFECTION AFTER OPERATIVE TREATMENT FOR HIP FRACTURE.

Abstract

Introduction: Older age is a risk factor for a poorer survival prognosis after hip fracture. Some other variables, such as male sex, dependency and dementia also contribute to a worse result expectations. However, since the association between surgery complications and other variables, such as age has been poorly researched, in this paper we study, within a major project on hip fractures, the association between age and nosocomial infections after hip fracture surgical treatment.

Material and Methods: We have designed a cohort study and have followed them after surgery with the aim of studying NI rates. We reviewed the records of all patients operated on for hip fracture in our Institution between 2006, and 2008. Data on all hip fractures were prospectively collected as from patient admission. The data collection was based on the “Minimum Data Base Group” at our National Health System. Together with affiliation, full clinical history, and also complications are all included in our Hospital data base. We considered a nosocomial infection (NI) as any infection developed within three months after a main surgical procedure was addressed for a hip fracture (infection either at the surgical site, pneumonia, urological infection, or others). Patients were classified, in terms of co-morbibidity, according to worldwide accepted Charlson et al criteria. A univariate and multivariate analysis were performed, by using simple and multiple logistic regression model.

Results: We collected 912 patients operated on for a hip fracture. Age was associated to infection, either in considering it alone (crude OR 0,96, CI of 95% = 0,95; 0,97; p=0,0004) or in considering it together with the other variables (multivariate analysis: adjusted OR 1,04; CI of 95% = 1,01; 1,07; p=0,007). None of the other variables were associated to nosocomial infection. Mental disease (crude OR 0,79, CI of 95% = 0,41; 1,53; p=0,49; adjusted OR 0,74, CI of 95% = 0,37;1,46; p=0,38), gender (OR=0,93 [CI of 95% 0,51; 1,68] p=0,78; adjusted OR=1,14 [0,62; 2,10] p=0,67), or co-morbidities (crude OR for index 1: 1,07 [CI of 95% 0,60; 1,90]; OR=1,07 [CI of 95% 0,43; 2,65] p=0,97) adjusted OR for index 1: 0,99 [CI of 95% 0,54; 1,80] p=0,97], for index 2, which includes 2–7, OR=1,02 [CI of 95% 0,40; 2,62] p=0,96).

Discussion: Since age, in this research, has shown to have a definite correlation with nosocomial infections, whenever older patients are operated on for hip fracture treatment, prophylactic protocols for infection prevention should be individualized, according to patient age. The likelihood of adding communitarian infections when studying non surgical site infections, incubated before or after hospital stay is unknown. However, since the earliest infection developed at the second hospitalization day, we believe that the aim of this research is not affected for that.