Hospital variation in the risk of infection after hip fracture surgery: a population-based cohort study including 29,598 patients from 2012-2017.

Abstract:

:Background and purpose - Understanding the key drivers of hospital variation in postoperative infections after hip fracture surgery is important for directing quality improvements. Therefore, we investigated variation in the risk of any infection, and subgroups of infections including pneumonia and sepsis after hip fracture surgery. Methods - In this nationwide population-based cohort study, all Danish patients aged ≥ 65 undergoing surgery for an incident hip fracture from 2012 to 2017 were included. Risk of postoperative infections, based on data from hospital registration (hospital-treated infections) and antibiotic dispensing (community-treated infections), were calculated using multilevel Poisson regression analysis. Hospital variation was evaluated by intra-class coefficient (ICC) and median risk ratio (MRR). Results - The risk of hospital-treated infection was 15%. The risk of community-treated infection was 24%. The adjusted risk varied between hospitals from 7.8-25% for hospital-treated infection and 16-34% for community-treated infection. The ICC indicated that 19% of the adjusted variance was due to hospital level for hospital-treated infection. The ICC for community-treated infections was 13%. The MRR showed a 2-fold increased risk for the average patient acquiring a hospital-treated infection at the highest risk hospital compared with the lowest risk hospital. For community-treated infection, the MRR was 1.4. Interpretation - Our results suggest that 20% of infections could be reduced by applying the top performing hospitals' approach. Nearly a 5th of the variation was at the hospital level. This suggests a more standardized approach to avoid postoperative infection after hip fracture surgery. Hip fracture is a leading cause of hospital admission among the elderly. The 30-day mortality following hip fracture surgery has been approximately 10% during the last few years in Denmark (Pedersen et al. 2017). Higher mortality after hip fracture has been associated with a range of hospital factors (Kristensen et al. 2016, Sheehan et al. 2016) and patient factors in observational studies (Roche et al. 2005). Furthermore, variation in 30-day mortality after hip fracture surgery has been observed between Danish hospitals, but not fully explained (Kristensen et al. 2019).

journal_name

Acta Orthop

journal_title

Acta orthopaedica

authors

Vesterager JD,Kristensen PK,Petersen I,Pedersen AB

doi

10.1080/17453674.2020.1863688

subject

Has Abstract

pub_date

2020-12-18 00:00:00

pages

1-7

eissn

1745-3674

issn

1745-3682

pub_type

杂志文章
  • Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report on 401 cases from the Norwegian Arthroplasty Register 1994-2017.

    abstract::Background and purpose - The number of primary, highly constrained knee arthroplasty implants has increased with a theoretically increased risk of early failure. Therefore we analyzed the risk of all revision following total knee arthroplasty (TKA) in patients receiving a hinged or condylar constrained knee (CCK) comp...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453674.2019.1627638

    authors: Badawy M,Fenstad AM,Furnes O

    更新日期:2019-10-01 00:00:00

  • Improved quality of cartilage repair by bone marrow mesenchymal stem cells for treatment of an osteochondral defect in a cynomolgus macaque model.

    abstract:BACKGROUND AND PURPOSE:Integration of repaired cartilage with surrounding native cartilage is a major challenge for successful tissue-engineering strategies of cartilage repair. We investigated whether incorporation of mesenchymal stem cells (MSCs) into the collagen scaffold improves integration and repair of cartilage...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453674.2014.958807

    authors: Araki S,Imai S,Ishigaki H,Mimura T,Nishizawa K,Ueba H,Kumagai K,Kubo M,Mori K,Ogasawara K,Matsusue Y

    更新日期:2015-02-01 00:00:00

  • Irradiation has no effect on the incorporation of impacted morselized bone: a bone chamber study in goats.

    abstract:BACKGROUND:Gamma irradiation has been widely used for sterilization of bone allografts. However, gamma irradiation alters proteins. This is favorable when it reduces immunogenicity, but is undesirable when osteoinductive proteins are damaged. Although the effect of gamma irradiation on BMPs has been studied, the effect...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453670610013394

    authors: Hannink G,Schreurs BW,Buma P

    更新日期:2007-02-01 00:00:00

  • Uncemented or cemented revision stems? Analysis of 2,296 first-time hip revision arthroplasties performed due to aseptic loosening, reported to the Swedish Hip Arthroplasty Register.

    abstract::Background and purpose - Uncemented stems are increasingly used in revision hip arthroplasty, but only a few studies have analyzed the outcomes of uncemented and cemented revision stems in large cohorts of patients. We compared the results of uncemented and cemented revision stems. Patients and methods - 1,668 uncemen...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453674.2019.1624336

    authors: Tyson Y,Rolfson O,Kärrholm J,Hailer NP,Mohaddes M

    更新日期:2019-10-01 00:00:00

  • Continuous adductor canal block added to local infiltration analgesia (LIA) after total knee arthroplasty has no additional benefits on pain and ambulation on postoperative day 1 and 2 compared with LIA alone.

    abstract::Background and purpose - The additional effects of a continuous adductor canal block (ACB) compared with a single-dose local infiltration anesthesia (LIA) after total knee arthroplasty (TKA) has not been widely researched. Both methods have good effect individually. We hypothesized that a continuous ACB added to a sin...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章,随机对照试验

    doi:10.1080/17453674.2017.1342184

    authors: Gudmundsdottir S,Franklin JL

    更新日期:2017-10-01 00:00:00

  • Lower 5-year cup re-revision rate for dual mobility cups compared with unipolar cups: report of 15,922 cup revision cases in the Dutch Arthroplasty Register (2007-2016).

    abstract::Background and purpose - During revision hip arthroplasty the dual mobility cup (DMC) is widely used to prevent dislocation despite limited knowledge of implant longevity. We determined the 5-year cup re-revision rates of DMC compared with unipolar cups (UC) following cup revisions in the Netherlands. Patients and met...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453674.2019.1617560

    authors: Bloemheuvel EM,Steenbergen LNV,Swierstra BA

    更新日期:2019-08-01 00:00:00

  • Polymethylmethacrylate causes prolonged pulmonary hypertension during fat embolism: a study in sheep.

    abstract:BACKGROUND:Fat embolism (FE), the release of bone marrow contents into the circulation and the subsequent cardiovascular changes, is still a potentially fatal com-plication during orthopedic surgery. Different causative factors have been suggested, but the exact pathomechanism of FE still remains unclear. We investigat...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453670510045570

    authors: Aebli N,Schwenke D,Davis G,Hii T,Theis JC,Krebs J

    更新日期:2005-12-01 00:00:00

  • Health-related quality of life and self-reported ability concerning ADL and IADL after hip fracture: a randomized trial.

    abstract:BACKGROUND:It is not known whether postoperative occupational therapy is of value for hip fracture patients. In this randomized trial we evaluated the effects of an individualized, postoperative, occupational training (OT) program on the patient's self-reported health-related quality of life (HRQL) and self-reported ab...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章,随机对照试验

    doi:10.1080/17453670610045786

    authors: Hagsten B,Svensson O,Gardulf A

    更新日期:2006-02-01 00:00:00

  • Outcome assessment of hemiarthroplasty of the shoulder: a 5-year follow-up with 4 evaluation tools.

    abstract:BACKGROUND:Outcome measurement of shoulder arthroplasty is not standardized. We compared 3 scores and 1 evaluation form. PATIENTS AND METHODS:We report on 35 hemiarthroplasties of the shoulder (32 cementless). Mean age of the patients was 62 (29-87) years. After a mean follow-up of 6 years (range 2-18 years) patients ...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453670610012980

    authors: Krepler P,Wanivenhaus AH,Wurnig C

    更新日期:2006-10-01 00:00:00

  • Low bone mineral density is not related to failure in femoral neck fracture patients treated with internal fixation.

    abstract:BACKGROUND AND PURPOSE:Internal fixation (IF) in femoral neck fractures has high reoperation rates and some predictors of failure are known, such as age, quality of reduction, and implant positioning. Finding new predictors of failure is an ongoing process, and in this study we evaluated the importance of low bone mine...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453674.2013.875360

    authors: Viberg B,Ryg J,Overgaard S,Lauritsen J,Ovesen O

    更新日期:2014-02-01 00:00:00

  • Dislocation of total hip replacement in patients with fractures of the femoral neck.

    abstract:BACKGROUND:Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors infl...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453670902930024

    authors: Enocson A,Hedbeck CJ,Tidermark J,Pettersson H,Ponzer S,Lapidus LJ

    更新日期:2009-04-01 00:00:00

  • Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty.

    abstract:BACKGROUND AND PURPOSE:Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of--and risk factors for--intraoperative calcar fracture, and assessed its influence on the risk of revision. PATIENTS AND METHODS:This retrospective ana...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453674.2015.1112712

    authors: Miettinen SS,Mäkinen TJ,Kostensalo I,Mäkelä K,Huhtala H,Kettunen JS,Remes V

    更新日期:2016-01-01 00:00:00

  • Cementless CUT femoral neck prosthesis: increased rate of aseptic loosening after 5 years.

    abstract:BACKGROUND:Bone-saving hip arthroplasty techniques, which facilitate revision, are gaining importance as the number of hip replacements in younger patients increases. PATIENTS AND METHODS:123 CUT femoral neck prostheses (ESKA Implants, Lübeck, Germany) were implanted in 113 patients (average age 53 years) between 1999...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453670710014301

    authors: Ender SA,Machner A,Pap G,Hubbe J,Grashoff H,Neumann HW

    更新日期:2007-10-01 00:00:00

  • External fixation of fractures of the distal radius: a randomized comparison of the Hoffman compact II non-bridging fixator and the Dynawrist fixator in 75 patients followed for 1 year.

    abstract:BACKGROUND AND PURPOSE:External fixators allowing movement during fracture healing are commonly used for treatment of unstable distal radius fractures. The dynamic Dynawrist fixator with the distal pins in metacarpal bone may avoid fixation problems in comminuted fractures and may reduce the risk of nerve injury. We co...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章,随机对照试验

    doi:10.1080/17453670902807433

    authors: Krukhaug Y,Ugland S,Lie SA,Hove LM

    更新日期:2009-02-01 00:00:00

  • Good sensitivity and specificity of ultrasound for detecting pseudotumors in 83 failed metal-on-metal hip replacements.

    abstract:BACKGROUND AND PURPOSE:Ultrasound is used for imaging of pseudotumors associated with metal-on-metal (MoM) hips. Ultrasound has been compared with magnetic resonance imaging, but to date there have been no studies comparing ultrasound findings and revision findings. METHODS:We evaluated the sensitivity and specificity...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453674.2014.1001970

    authors: Lainiala O,Elo P,Reito A,Pajamäki J,Puolakka T,Eskelinen A

    更新日期:2015-06-01 00:00:00

  • Variation in outcome and ranking of hospitals: an analysis from the Swedish knee arthroplasty register.

    abstract:BACKGROUND:Hospital-specific variation in outcome is generally considered to be an important source of information for clinical improvement. We have measured the magnitude of this variation. METHODS:We determined the revision risk in 37,642 cemented primary total knee arthroplasties inserted as a result of osteoarthri...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453670610046442

    authors: Robertsson O,Ranstam J,Lidgren L

    更新日期:2006-06-01 00:00:00

  • Changes in lower limb rotation after soft tissue surgery in spastic diplegia.

    abstract:BACKGROUND AND PURPOSE:Rotational osteotomies are usually necessary to correct pronounced rotational deformities in ambulant children with cerebral palsy. The effects of soft tissue surgery on such deformities are unclear. In this retrospective study, we determined whether multilevel soft tissue surgery, performed to c...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453671003587135

    authors: Lofterød B,Terjesen T

    更新日期:2010-04-01 00:00:00

  • The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients.

    abstract::Background and purpose - Smoking is a modifiable risk factor that may adversely affect postoperative outcomes. Healthcare providers are increasingly denying smokers access to total hip and knee arthroplasty (THA and TKA) until they stop smoking. Evidence supporting this is unclear. We assessed the effect of smoking on...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453674.2019.1649510

    authors: Matharu GS,Mouchti S,Twigg S,Delmestri A,Murray DW,Judge A,Pandit HG

    更新日期:2019-12-01 00:00:00

  • No effect of risedronate on femoral periprosthetic bone loss following total hip arthroplasty. A 4-year follow-up of 61 patients in a double-blind, randomized placebo-controlled trial.

    abstract:BACKGROUND AND PURPOSE:We have previously shown that during the first 2 years after total hip arthroplasty (THA), periprosthetic bone resorption can be prevented by 6 months of risedronate therapy. This follow-up study investigated this effect at 4 years. PATIENTS AND METHODS:A single-center, double-blind, randomized ...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章,随机对照试验

    doi:10.3109/17453674.2015.1041846

    authors: Muren O,Akbarian E,Salemyr M,Bodén H,Eisler T,Stark A,Sköldenberg O

    更新日期:2015-01-01 00:00:00

  • Cyclooxygenase-2 inhibitor delays fracture healing in rats.

    abstract:BACKGROUND:Cyclooxigenase-2 (COX-2) inhibitors have been reported to delay fracture healing. To investigate the major inhibitory period of COX-2 inhibitors in fracture healing, we administrated etodolac, a COX-2-specific inhibitor, to a rat fracture model by altering the period of administration from early to late. ME...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453670510041439

    authors: Endo K,Sairyo K,Komatsubara S,Sasa T,Egawa H,Ogawa T,Yonekura D,Murakami R,Yasui N

    更新日期:2005-08-01 00:00:00

  • A new standard radiographic reference for proximal fibular height in children.

    abstract::Background and purpose - To date there is a lack of studies defining the anatomical position of the proximal fibula. This is especially relevant when planning surgical interventions affecting the knee joint such as permanent or temporary epiphysiodesis to correct leg length discrepancies or angular deformities in grow...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453674.2020.1769378

    authors: Frommer A,Niemann M,Gosheger G,Toporowski G,Laufer A,Eveslage M,Bröking JN,Rödl R,Vogt B

    更新日期:2020-10-01 00:00:00

  • The effect of middle-age body weight and physical activity on the risk of early revision hip arthroplasty: a cohort study of 1,535 individuals.

    abstract:BACKGROUND:Overweight and a high level of physical activity are known risk factors for loosening of a total hip arthroplasty (THA) due to primary osteoarthritis. We wanted to investigate how these factors, together with age and sex, affect the risk of revision surgery. PATIENTS AND METHODS:We matched data from the Nor...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453670610013493

    authors: Flugsrud GB,Nordsletten L,Espehaug B,Havelin LI,Meyer HE

    更新日期:2007-02-01 00:00:00

  • A vitamin E blended highly cross-linked polyethylene acetabular cup results in less wear: 6-year results of a randomized controlled trial in 199 patients.

    abstract::Background and purpose - Survivorship of total hip arthroplasty (THA) with the ultra-high molecular weight polyethylene (UHMWPE) monoblock cup has been limited due to periprosthetic osteolysis and aseptic loosening, secondary to wear of the UHMWPE. In response, a vitamin E blended highly cross-linked polyethylene (HXL...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453674.2020.1807220

    authors: Massier JRA,Van Erp JHJ,Snijders TE,Gast A

    更新日期:2020-12-01 00:00:00

  • Alteration of the material properties of the normal supraspinatus tendon by nicotine treatment in a rat model.

    abstract:BACKGROUND AND PURPOSE:Several studies have shown that nicotine has a detrimental effect on the development of rotator cuff tear. However, little is known about its mechanism. We evaluated the effect of nicotine on the maximum tensile load, the maximum tensile stress, and the elastic modulus of the supraspinatus tendon...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453674.2010.524595

    authors: Ichinose R,Sano H,Kishimoto KN,Sakamoto N,Sato M,Itoi E

    更新日期:2010-10-01 00:00:00

  • Biodegradable X-ray markers of controlled radio-opacity. Temporary position measurements in bone.

    abstract::In order to analyze X-ray markers for potential use in biodegradable implants or radiostereogrammatic analysis (RSA), we combined iopromide contrast fluid with biodegradable calcium phosphate cement. The radio-opacity of 10 x 10 mm markers containing different iodine concentrations (0, 120, 240, 360 and 720 mg per gra...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/00016470510030445

    authors: Stallmann HP,Faber C,Plokker HM,Wuisman PI

    更新日期:2005-02-01 00:00:00

  • Bone mineral density changes in the graft after acetabular impaction bone grafting in primary and revision hip surgery.

    abstract::Background and purpose - Impaction bone grafting (IBG) is an established method in hip revision surgery to reconstruct loss of bone stock. There is limited knowledge concerning the actual bone remodelling process within the allograft. We investigated with repeated bone mineral density (BMD) measurements the biological...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453674.2018.1460776

    authors: Gerhardt DMJM,De Visser E,Hendrickx BW,Schreurs BW,Van Susante JLC

    更新日期:2018-06-01 00:00:00

  • Functional results of hemi- and total shoulder arthroplasty according to diagnosis and patient age at surgery.

    abstract::Background and purpose - There is a lack of information on any associations between the functional outcome and age and diagnosis in patients who have undergone shoulder arthroplasty. We therefore evaluated the functional outcome in "young" and "old" patients treated with either hemiarthroplasty (HA) or total shoulder ...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.1080/17453674.2017.1280656

    authors: Sowa B,Thierjung H,Bülhoff M,Loew M,Zeifang F,Bruckner T,Raiss P

    更新日期:2017-06-01 00:00:00

  • Effects of metal-on-metal wear on the host immune system and infection in hip arthroplasty.

    abstract:BACKGROUND AND PURPOSE:Joint replacement with metal-on-metal (MOM) bearings have gained popularity in the last decades in young and active patients. However, the possible effects of MOM wear debris and its corrosion products are still the subject of debate. Alongside the potential disadvantages such as toxicity, the in...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章,评审

    doi:10.3109/17453674.2010.519169

    authors: Hosman AH,van der Mei HC,Bulstra SK,Busscher HJ,Neut D

    更新日期:2010-10-01 00:00:00

  • Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register.

    abstract:BACKGROUND AND PURPOSE:Although total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide a...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453671003685459

    authors: Skyttä ET,Koivu H,Eskelinen A,Ikävalko M,Paavolainen P,Remes V

    更新日期:2010-02-01 00:00:00

  • Development of the Knee Injury and Osteoarthritis Outcome Score for children (KOOS-Child): comprehensibility and content validity.

    abstract:BACKGROUND AND PURPOSE:The Knee Injury and Osteoarthritis Outcome Score (KOOS) is distinguished from other knee-specific measures by the inclusion of separate scales for evaluation of activities of daily living, sports and recreation function, and knee-related quality of life, with presentation of separate subscale sco...

    journal_title:Acta orthopaedica

    pub_type: 杂志文章

    doi:10.3109/17453674.2012.747921

    authors: Örtqvist M,Roos EM,Broström EW,Janarv PM,Iversen MD

    更新日期:2012-12-01 00:00:00