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Loss of pre-fracture basic mobility status at hospital discharge for hip fracture is associated with 30-day post-discharge risk of infections - a four-year nationwide cohort study of 23,309 Danish patients

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@article{bec480fbbbe8484b9e161fede273e747,
title = "Loss of pre-fracture basic mobility status at hospital discharge for hip fracture is associated with 30-day post-discharge risk of infections - a four-year nationwide cohort study of 23,309 Danish patients",
abstract = "BACKGROUND: The loss of pre-fracture basic mobility status is associated with increased mortality and any readmission after hip fracture. However, it is less known if the loss of pre-fracture mobility has impact on acquiring a post-discharge infection.PURPOSE: To examine if the loss of pre-fracture basic mobility status at hospital discharge was associated with hospital-treated or community-treated infections within 30-days of hospital discharge after hip fracture.METHODS: Using the nationwide Danish Multidisciplinary Hip Fracture Registry from January 2014 through November 2017, we included 23,309 patients undergoing surgery for a first-time hip fracture. The Cumulated Ambulation Score (CAS, 0-6 points) was recorded using questionnaire at admission (pre-fracture CAS) and objectively assessed at discharge. The loss of any CAS-points at discharge compared with pre-fracture CAS was calculated and dichotomized (yes/no). Using Cox regression analyses, we estimated the hazard ratio (HR) with 95% confidence interval (CI) of any hospital-treated infection, hospital-treated pneumonia or community-treated infection adjusted for sex, age, body mass index, Charlson Comorbidity Index, residential status, type of fracture, and length of hospital stay (LOS).RESULTS: Total of 12,046 (62%) patients lost their pre-fracture CAS status at discharge. Among patients who had lost their pre-fracture CAS, 6.0% developed a hospital-treated infection compared to 4% of those who did not lose their pre-fracture CAS. Correspondingly, 9.2% versus 6.2% developed a community-treated infection. The risk of 30-day post-discharge infection increased with increasing loss of any CAS points. The adjusted HRs for patients who had lost their pre-fracture CAS status, compared to patients who did not, was 1.34 (CI: 1.16-1.54) for hospital-treated infection, 1.35 (CI: 1.09 - 1.67) for pneumonia and 1.36 (CI: 1.21-1.52) for community-treated infection.CONCLUSION: In this large national cohort study, we found that loss of pre-fracture basic mobility status upon hospital discharge was strongly associated with 30-day post-discharge risk of developing infection. These findings suggest a clinical importance of carefully focusing on regaining the pre-fracture basic mobility before discharging the patient.",
keywords = "Aftercare, Cohort Studies, Denmark/epidemiology, Hip Fractures/surgery, Hospitals, Humans, Length of Stay, Patient Discharge, Risk Factors, Orthopedic, Physiotherapy, Mobility, Postoperative care, Infection, Hip fracture",
author = "Vesterager, {Jeppe D} and Kristensen, {Morten T} and Pedersen, {Alma B}",
note = "Publisher Copyright: {\textcopyright} 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = jul,
doi = "10.1016/j.injury.2021.04.037",
language = "English",
volume = "52",
pages = "1833--1840",
journal = "Injury",
issn = "0020-1383",
publisher = "Elsevier Ltd",
number = "7",

}

RIS

TY - JOUR

T1 - Loss of pre-fracture basic mobility status at hospital discharge for hip fracture is associated with 30-day post-discharge risk of infections - a four-year nationwide cohort study of 23,309 Danish patients

AU - Vesterager, Jeppe D

AU - Kristensen, Morten T

AU - Pedersen, Alma B

N1 - Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/7

Y1 - 2021/7

N2 - BACKGROUND: The loss of pre-fracture basic mobility status is associated with increased mortality and any readmission after hip fracture. However, it is less known if the loss of pre-fracture mobility has impact on acquiring a post-discharge infection.PURPOSE: To examine if the loss of pre-fracture basic mobility status at hospital discharge was associated with hospital-treated or community-treated infections within 30-days of hospital discharge after hip fracture.METHODS: Using the nationwide Danish Multidisciplinary Hip Fracture Registry from January 2014 through November 2017, we included 23,309 patients undergoing surgery for a first-time hip fracture. The Cumulated Ambulation Score (CAS, 0-6 points) was recorded using questionnaire at admission (pre-fracture CAS) and objectively assessed at discharge. The loss of any CAS-points at discharge compared with pre-fracture CAS was calculated and dichotomized (yes/no). Using Cox regression analyses, we estimated the hazard ratio (HR) with 95% confidence interval (CI) of any hospital-treated infection, hospital-treated pneumonia or community-treated infection adjusted for sex, age, body mass index, Charlson Comorbidity Index, residential status, type of fracture, and length of hospital stay (LOS).RESULTS: Total of 12,046 (62%) patients lost their pre-fracture CAS status at discharge. Among patients who had lost their pre-fracture CAS, 6.0% developed a hospital-treated infection compared to 4% of those who did not lose their pre-fracture CAS. Correspondingly, 9.2% versus 6.2% developed a community-treated infection. The risk of 30-day post-discharge infection increased with increasing loss of any CAS points. The adjusted HRs for patients who had lost their pre-fracture CAS status, compared to patients who did not, was 1.34 (CI: 1.16-1.54) for hospital-treated infection, 1.35 (CI: 1.09 - 1.67) for pneumonia and 1.36 (CI: 1.21-1.52) for community-treated infection.CONCLUSION: In this large national cohort study, we found that loss of pre-fracture basic mobility status upon hospital discharge was strongly associated with 30-day post-discharge risk of developing infection. These findings suggest a clinical importance of carefully focusing on regaining the pre-fracture basic mobility before discharging the patient.

AB - BACKGROUND: The loss of pre-fracture basic mobility status is associated with increased mortality and any readmission after hip fracture. However, it is less known if the loss of pre-fracture mobility has impact on acquiring a post-discharge infection.PURPOSE: To examine if the loss of pre-fracture basic mobility status at hospital discharge was associated with hospital-treated or community-treated infections within 30-days of hospital discharge after hip fracture.METHODS: Using the nationwide Danish Multidisciplinary Hip Fracture Registry from January 2014 through November 2017, we included 23,309 patients undergoing surgery for a first-time hip fracture. The Cumulated Ambulation Score (CAS, 0-6 points) was recorded using questionnaire at admission (pre-fracture CAS) and objectively assessed at discharge. The loss of any CAS-points at discharge compared with pre-fracture CAS was calculated and dichotomized (yes/no). Using Cox regression analyses, we estimated the hazard ratio (HR) with 95% confidence interval (CI) of any hospital-treated infection, hospital-treated pneumonia or community-treated infection adjusted for sex, age, body mass index, Charlson Comorbidity Index, residential status, type of fracture, and length of hospital stay (LOS).RESULTS: Total of 12,046 (62%) patients lost their pre-fracture CAS status at discharge. Among patients who had lost their pre-fracture CAS, 6.0% developed a hospital-treated infection compared to 4% of those who did not lose their pre-fracture CAS. Correspondingly, 9.2% versus 6.2% developed a community-treated infection. The risk of 30-day post-discharge infection increased with increasing loss of any CAS points. The adjusted HRs for patients who had lost their pre-fracture CAS status, compared to patients who did not, was 1.34 (CI: 1.16-1.54) for hospital-treated infection, 1.35 (CI: 1.09 - 1.67) for pneumonia and 1.36 (CI: 1.21-1.52) for community-treated infection.CONCLUSION: In this large national cohort study, we found that loss of pre-fracture basic mobility status upon hospital discharge was strongly associated with 30-day post-discharge risk of developing infection. These findings suggest a clinical importance of carefully focusing on regaining the pre-fracture basic mobility before discharging the patient.

KW - Aftercare

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Hip Fractures/surgery

KW - Hospitals

KW - Humans

KW - Length of Stay

KW - Patient Discharge

KW - Risk Factors

KW - Orthopedic

KW - Physiotherapy

KW - Mobility

KW - Postoperative care

KW - Infection

KW - Hip fracture

UR - http://www.scopus.com/inward/record.url?scp=85105006289&partnerID=8YFLogxK

U2 - 10.1016/j.injury.2021.04.037

DO - 10.1016/j.injury.2021.04.037

M3 - Journal article

C2 - 33941387

VL - 52

SP - 1833

EP - 1840

JO - Injury

JF - Injury

SN - 0020-1383

IS - 7

ER -

ID: 65429373