1887
Research Open Access
Like 0

Abstract

Background

Older age is frequently cited as a risk factor for healthcare-associated infections in general, and surgical site infections (SSIs) specifically.

Aim

We aimed to investigate the correlation between age and SSI occurrence.

Methods

Data on total hip replacement (THR) and total knee replacement (TKR) surgeries and resulting SSIs documented in the German national surveillance network from a 10-year period from 2009 to 2018 were selected for analysis. SSI rates and adjusted odds ratios (AOR) were calculated and a multivariable analysis to determine risk factors for SSI occurrence was conducted.

Results

A total of 418,312 THR procedures resulting in 3,231 SSIs, and 286,074 TKR procedures with 1,288 SSIs were included in the analyses. For THR, SSI rates were higher in older age groups when compared with the reference age group of 61–65 years. A significantly higher risk was observed in the 76–80 years age group (AOR: 1.21, 95% CI: 1.05–1.4). An age of ≤ 50 years was associated with a significantly lower SSI risk (AOR: 0.64, 95% CI: 0.52–0.8). For TKR, a similar correlation was observed, with the exception of the youngest age group (≤ 52 years), which was shown to have an SSI risk equal to that of the knee prosthesis reference age group (78–82 years).

Conclusion

A strong correlation between increasing age and SSI occurrence was observed for both procedure types. The results of our analyses provide a basis to consider future targeted SSI prevention measures for different age groups.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.9.2200535
2023-03-02
2024-06-25
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.9.2200535
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/9/eurosurv-28-9-3.html?itemId=/content/10.2807/1560-7917.ES.2023.28.9.2200535&mimeType=html&fmt=ahah

References

  1. Oeppen J, Vaupel JW. Demography. Broken limits to life expectancy. Science. 2002;296(5570):1029-31.  https://doi.org/10.1126/science.1069675  PMID: 12004104 
  2. Janssen F, Bardoutsos A, El Gewily S, De Beer J. Future life expectancy in Europe taking into account the impact of smoking, obesity, and alcohol. Elife. 2021;10:e66590.  https://doi.org/10.7554/eLife.66590  PMID: 34227469 
  3. Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis. 2002;2(11):659-66.  https://doi.org/10.1016/S1473-3099(02)00437-1  PMID: 12409046 
  4. Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Nihon Ronen Igakkai Zasshi. [Reviewing the definition of elderly]. Japanese. 2006;43(1):27-34.  PMID: 16521795 
  5. Katz MJ, Roghmann MC. Healthcare-associated infections in the elderly: what’s new. Curr Opin Infect Dis. 2016;29(4):388-93.  https://doi.org/10.1097/QCO.0000000000000283  PMID: 27306562 
  6. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516.  https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516  PMID: 30458912 
  7. Schröder C, Schwab F, Behnke M, Breier AC, Maechler F, Piening B, et al. Epidemiology of healthcare associated infections in Germany: Nearly 20 years of surveillance. Int J Med Microbiol. 2015;305(7):799-806.  https://doi.org/10.1016/j.ijmm.2015.08.034  PMID: 26358916 
  8. European Centre for Disease Prevention and Control (ECDC). Healthcare-associated infections: surgical site infections. Annual epidemiological report for 2017. Stockholm: ECDC; 2019. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/AER_for_2017-SSI.pdf
  9. Organisation for Economic Cooperation and Development (OECD). Health at a Glance 2019: OECD Indicators. Hip and knee replacement. Paris: OECD. [Accessed: 1 Jul 2022]. Available from: https://www.oecd-ilibrary.org/sites/2fc83b9a-en/index.html?itemId=/content/component/2fc83b9a-en
  10. Alfonso-Sanchez JL, Martinez IM, Martín-Moreno JM, González RS, Botía F. Analyzing the risk factors influencing surgical site infections: the site of environmental factors. Can J Surg. 2017;60(3):155-61.  https://doi.org/10.1503/cjs.017916  PMID: 28234221 
  11. Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, et al. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One. 2013;18;8(12):e83743.  https://doi.org/10.1371/journal.pone.0083743  PMID:24367612 https://doi.org/10.1371/journal.pone.0083743 
  12. Gastmeier P, Sohr D, Schwab F, Behnke M, Zuschneid I, Brandt C, et al. Ten years of KISS: the most important requirements for success. J Hosp Infect. 2008;70(Suppl 1):11-6.  https://doi.org/10.1016/S0195-6701(08)60005-5  PMID: 18994676 
  13. European Centre for Disease Prevention and Control (ECDC). Surveillance of surgical site infections and prevention indicators in European hospitals. HAI-Net SSI protocol, version 2.2. Stockholm: ECDC; 2017. Available from: https://www.ecdc.europa.eu/sites/portal/files/documents/HAI-Net-SSI-protocol-v2.2.pdf
  14. Brandt C, Hansen S, Sohr D, Daschner F, Rüden H, Gastmeier P. Finding a method for optimizing risk adjustment when comparing surgical-site infection rates. Infect Control Hosp Epidemiol. 2004;25(4):313-8.  https://doi.org/10.1086/502398  PMID: 15108729 
  15. American Society of Anesthesiologists (ASA). ASA Physical Status Classification System. Washington: ASA. [Accessed: 1 Jul 2022]. Available from: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
  16. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2020. Available from: http://www.Rproject.org/
  17. Cruz E, Cano JR, Benitez-Parejo N, Rivas-Ruiz F, Perea-Milla E, Guerado E. Age as a risk factor of nosocomial infection after hip fracture surgery. Hip Int. 2010;20(7_suppl) Suppl 7;S19-25.  PMID: 20512767 
  18. Kaye KS, Schmit K, Pieper C, Sloane R, Caughlan KF, Sexton DJ, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis. 2005;191(7):1056-62.  https://doi.org/10.1086/428626  PMID: 15747239 
  19. Kaye KS, Schmader KE, Sawyer R. Surgical site infection in the elderly population. Clin Infect Dis. 2004;39(12):1835-41.  https://doi.org/10.1086/425744  PMID: 15578408 
  20. Cheadle WG. Risk factors for surgical site infection. Surg Infect (Larchmt). 2006;7(s1) Suppl 1;S7-11.  https://doi.org/10.1089/sur.2006.7.s1-7  PMID: 16834549 
  21. Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br. 2005;87(6):844-50.  https://doi.org/10.1302/0301-620X.87B6.15121  PMID: 15911671 
  22. Wu C, Qu X, Liu F, Li H, Mao Y, Zhu Z. Risk factors for periprosthetic joint infection after total hip arthroplasty and total knee arthroplasty in Chinese patients. PLoS One. 2014;9(4):e95300.  https://doi.org/10.1371/journal.pone.0095300  PMID: 24748009 
  23. Yang J, Zhang X, Liang W. A retrospective analysis of factors affecting surgical site infection in orthopaedic patients. J Int Med Res. 2020;48(4):300060520907776.  https://doi.org/10.1177/0300060520907776  PMID: 32281431 
  24. Raymond DP, Pelletier SJ, Crabtree TD, Schulman AM, Pruett TL, Sawyer RG. Surgical infection and the aging population. Am Surg. 2001;67(9):827-32, discussion 832-3.  https://doi.org/10.1177/000313480106700903  PMID: 11565758 
  25. Yoshikawa TT. Epidemiology and unique aspects of aging and infectious diseases. Clin Infect Dis. 2000;30(6):931-3.  https://doi.org/10.1086/313792  PMID: 10880303 
  26. Castle SC. Clinical relevance of age-related immune dysfunction. Clin Infect Dis. 2000;31(2):578-85.  https://doi.org/10.1086/313947  PMID: 10987724 
  27. Gibbons C, Bruce J, Carpenter J, Wilson AP, Wilson J, Pearson A, et al. Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Health Technol Assess. 2011;15(30):1-156, iii-iv.  https://doi.org/10.3310/hta15300  PMID: 21884656 
  28. Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty. 2009;24(6) Suppl;84-8.  https://doi.org/10.1016/j.arth.2009.05.016  PMID: 19604665 
  29. Endoprosthesis Registry Germany (EPRD). Jahresbericht 2019. Mit Sicherheit mehr Qualität. [Yearly Report 2019. More quality with safety]. Berlin: EPRD; 2019. German. Available from: https://www.eprd.de/fileadmin/user_upload/Jahresbericht_2019_doppelseite_2.0.pdf
  30. van Walraven C, Musselman R. The surgical site infection risk score (SSIRS): a model to predict the risk of surgical site infections. PLoS One. 2013;8(6):e67167.  https://doi.org/10.1371/journal.pone.0067167  PMID: 23826224 
  31. Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect (Larchmt). 2017;18(6):722-35.  https://doi.org/10.1089/sur.2017.089  PMID: 28832271 
  32. Aghdassi SJS, Schröder C, Gastmeier P. Gender-related risk factors for surgical site infections. Results from 10 years of surveillance in Germany. Antimicrob Resist Infect Control. 2019;3;8:95.  https://doi.org/10.1186/s13756-019-0547-x  PMID: 31171966
  33. Aghdassi SJS, Schwab F, Hoffmann P, Gastmeier P. The association of climatic factors with rates of surgical site infections: 17 years’ data from hospital infection surveillance. Dtsch Arztebl Int. 2019;116(31-32):529-36. PMID: 31554540 
/content/10.2807/1560-7917.ES.2023.28.9.2200535
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error