Risk of pneumonia and urinary tract infection within the first week after total hip arthroplasty and the impact on survival
Received 20 September 2016
Accepted for publication 13 December 2016
Published 23 January 2017 Volume 2017:9 Pages 31—39
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Lucy Goodman
Peer reviewer comments 3
Editor who approved publication: Professor Henrik Toft Sørensen
Eva N Glassou,1,2 Torben B Hansen,1,3 Alma B Pedersen2
1University Clinic of Hand, Hip and Knee Surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland, Aarhus University, 2Department of Clinical Epidemiology, Aarhus University Hospital, 3The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Aarhus University, Aarhus, Denmark
Background: Pneumonia and urinary tract infections (UTIs) increase morbidity and mortality. There is little epidemiological evidence from large population-based studies on risk factors for these infections and subsequent mortality in total hip arthroplasty (THA) patients.
Aim: To examine the risk factors of postoperative pneumonia and UTI after THA and their impact on survival.
Patients and methods: We used the Danish Hip Arthroplasty Register to identify THAs due to osteoarthritis registered from 2000 to 2013. We collected data about comorbidities, mortality and infections in relation to primary hospitalization and potential predictive variables from administrative databases. Regression models were used to estimate associations between potential risk factors and infection, and subsequently, between infection and mortality.
Results: In total 84,812 THAs were included. The cumulative incidence of pneumonia and UTI within 7 days of the primary procedure were 0.21 (95% confidence interval [CI]: 0.18–0.25) and 0.29 (95% CI: 0.26–0.33), respectively. Patient-related risk factors for infection were being 80 years or older, gender and a comorbidity burden at time of surgery. The hazard ratio (HR) of dying within 90 days of the primary THA was 10.67 (95% CI: 5.79–19.57) compared to patients without pneumonia. For patients with UTIs, the HR was 1.64 (95% CI: 0.41–6.59) compared to those without a UTI.
Conclusion: Pneumonia was associated with an increased short-term risk of dying, despite adjustment for coexisting comorbidity and other potential confounders. Age, gender and comorbidity were the most important risk factors for pneumonia and UTIs. Individual initiatives to reduce the risk of pneumonia in select patient groups may be essential to the effort to optimize outcomes after a THA.
Keywords: total hip arthroplasty, pneumonia, urinary tract infection, mortality, risk factor, prognosis
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