Interaction Between Multimorbidity and Hip Fracture Surgery Leads to Excess Risk of Infection: A Danish Registry-Based Cohort Study of 92,599 Patients With Hip Fracture

Cecilia Majlund Hansen; Nadia R. Gadgaard; Christina Vandenbroucke-Grauls; Nils P. Hailer; Alma Becic Pedersen

doi:10.2147/CLEP.S507252

Interaction Between Multimorbidity and Hip Fracture Surgery Leads to Excess Risk of Infection: A Danish Registry-Based Cohort Study of 92,599 Patients With Hip Fracture

Cecilia Majlund Hansen, Nadia R. Gadgaard, Christina Vandenbroucke-Grauls, Nils P. Hailer, Alma Becic Pedersen^*

^*Corresponding author for this work

Department of Clinical Medicine - Department of Clinical Epidemiology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Purpose: Infection in general is a frequent and serious complication after hip fracture (HF) surgery. Multimorbidity in HF patients is associated with elevated infection risk. It remains unclear whether multimorbidity interacts with HF surgery to increase infection risk beyond their individual effects. Methods: Using Danish registries, we identified 92,599 patients ≥65 years surgically treated for HF 2004 to 2018 and an age-and sex-matched comparison cohort from the background population without HF (n=462,993). Multimorbidity was defined using the Charlson Comorbidity Index in categories no, moderate, or severe. We computed incidence rates (IR) of any kind of hospital-treated infection within 1 month and 1 year with 95% confidence intervals and estimated the attributable proportion (in %) based on differences in IRs. Results: The IR of infection within 1 month was 181 (176–186) per 100 person years in HF patients with no multimorbidity and 9 (95% CI 8–9) in the comparison cohort with no multimorbidity. The IRs were 240 (234–246) and 302 (291–313) in HF patients with moderate and severe multimorbidity compared with 17 (16–18) and 31 (30–33) in the comparison cohort with same multimorbidity level. The attributable proportion indicates that 21% and 33% of the IR among HF patients with moderate and severe multimorbidity, respectively, was explained by interaction. Similar interactions were observed within 1 year. Conclusion: Multimorbidity and HF surgery interact synergistically, which substantially increases the infection risk. The interaction effect increased with multimorbidity level. Our findings highlight the potential benefits of implementing more targeted and personalized preventive initiatives for multimorbid patients.

Original language	English
Journal	Clinical epidemiology
Volume	17
Pages (from-to)	167-176
Number of pages	10
ISSN	1179-1349
DOIs	https://doi.org/10.2147/CLEP.S507252
Publication status	Published - 2025

Keywords

comorbidity
epidemiology
hip fracture
infection
interaction
multimorbidity

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10.2147/CLEP.S507252

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@article{4476a789db7a47fa97e5b859e067657f,

title = "Interaction Between Multimorbidity and Hip Fracture Surgery Leads to Excess Risk of Infection: A Danish Registry-Based Cohort Study of 92,599 Patients With Hip Fracture",

abstract = "Purpose: Infection in general is a frequent and serious complication after hip fracture (HF) surgery. Multimorbidity in HF patients is associated with elevated infection risk. It remains unclear whether multimorbidity interacts with HF surgery to increase infection risk beyond their individual effects. Methods: Using Danish registries, we identified 92,599 patients ≥65 years surgically treated for HF 2004 to 2018 and an age-and sex-matched comparison cohort from the background population without HF (n=462,993). Multimorbidity was defined using the Charlson Comorbidity Index in categories no, moderate, or severe. We computed incidence rates (IR) of any kind of hospital-treated infection within 1 month and 1 year with 95% confidence intervals and estimated the attributable proportion (in %) based on differences in IRs. Results: The IR of infection within 1 month was 181 (176–186) per 100 person years in HF patients with no multimorbidity and 9 (95% CI 8–9) in the comparison cohort with no multimorbidity. The IRs were 240 (234–246) and 302 (291–313) in HF patients with moderate and severe multimorbidity compared with 17 (16–18) and 31 (30–33) in the comparison cohort with same multimorbidity level. The attributable proportion indicates that 21% and 33% of the IR among HF patients with moderate and severe multimorbidity, respectively, was explained by interaction. Similar interactions were observed within 1 year. Conclusion: Multimorbidity and HF surgery interact synergistically, which substantially increases the infection risk. The interaction effect increased with multimorbidity level. Our findings highlight the potential benefits of implementing more targeted and personalized preventive initiatives for multimorbid patients.",

keywords = "comorbidity, epidemiology, hip fracture, infection, interaction, multimorbidity",

author = "Hansen, {Cecilia Majlund} and Gadgaard, {Nadia R.} and Christina Vandenbroucke-Grauls and Hailer, {Nils P.} and Pedersen, {Alma Becic}",

note = "Publisher Copyright: {\textcopyright} 2025 Hansen et al.",

year = "2025",

doi = "10.2147/CLEP.S507252",

language = "English",

volume = "17",

pages = "167--176",

journal = "Clinical epidemiology",

issn = "1179-1349",

publisher = "Dove Medical Press Ltd",

}

Interaction Between Multimorbidity and Hip Fracture Surgery Leads to Excess Risk of Infection: A Danish Registry-Based Cohort Study of 92,599 Patients With Hip Fracture. / Hansen, Cecilia Majlund ; Gadgaard, Nadia R.; Vandenbroucke-Grauls, Christina et al.
In: Clinical epidemiology, Vol. 17, 2025, p. 167-176.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Interaction Between Multimorbidity and Hip Fracture Surgery Leads to Excess Risk of Infection

T2 - A Danish Registry-Based Cohort Study of 92,599 Patients With Hip Fracture

AU - Hansen, Cecilia Majlund

AU - Gadgaard, Nadia R.

AU - Vandenbroucke-Grauls, Christina

AU - Hailer, Nils P.

AU - Pedersen, Alma Becic

PY - 2025

Y1 - 2025

N2 - Purpose: Infection in general is a frequent and serious complication after hip fracture (HF) surgery. Multimorbidity in HF patients is associated with elevated infection risk. It remains unclear whether multimorbidity interacts with HF surgery to increase infection risk beyond their individual effects. Methods: Using Danish registries, we identified 92,599 patients ≥65 years surgically treated for HF 2004 to 2018 and an age-and sex-matched comparison cohort from the background population without HF (n=462,993). Multimorbidity was defined using the Charlson Comorbidity Index in categories no, moderate, or severe. We computed incidence rates (IR) of any kind of hospital-treated infection within 1 month and 1 year with 95% confidence intervals and estimated the attributable proportion (in %) based on differences in IRs. Results: The IR of infection within 1 month was 181 (176–186) per 100 person years in HF patients with no multimorbidity and 9 (95% CI 8–9) in the comparison cohort with no multimorbidity. The IRs were 240 (234–246) and 302 (291–313) in HF patients with moderate and severe multimorbidity compared with 17 (16–18) and 31 (30–33) in the comparison cohort with same multimorbidity level. The attributable proportion indicates that 21% and 33% of the IR among HF patients with moderate and severe multimorbidity, respectively, was explained by interaction. Similar interactions were observed within 1 year. Conclusion: Multimorbidity and HF surgery interact synergistically, which substantially increases the infection risk. The interaction effect increased with multimorbidity level. Our findings highlight the potential benefits of implementing more targeted and personalized preventive initiatives for multimorbid patients.

AB - Purpose: Infection in general is a frequent and serious complication after hip fracture (HF) surgery. Multimorbidity in HF patients is associated with elevated infection risk. It remains unclear whether multimorbidity interacts with HF surgery to increase infection risk beyond their individual effects. Methods: Using Danish registries, we identified 92,599 patients ≥65 years surgically treated for HF 2004 to 2018 and an age-and sex-matched comparison cohort from the background population without HF (n=462,993). Multimorbidity was defined using the Charlson Comorbidity Index in categories no, moderate, or severe. We computed incidence rates (IR) of any kind of hospital-treated infection within 1 month and 1 year with 95% confidence intervals and estimated the attributable proportion (in %) based on differences in IRs. Results: The IR of infection within 1 month was 181 (176–186) per 100 person years in HF patients with no multimorbidity and 9 (95% CI 8–9) in the comparison cohort with no multimorbidity. The IRs were 240 (234–246) and 302 (291–313) in HF patients with moderate and severe multimorbidity compared with 17 (16–18) and 31 (30–33) in the comparison cohort with same multimorbidity level. The attributable proportion indicates that 21% and 33% of the IR among HF patients with moderate and severe multimorbidity, respectively, was explained by interaction. Similar interactions were observed within 1 year. Conclusion: Multimorbidity and HF surgery interact synergistically, which substantially increases the infection risk. The interaction effect increased with multimorbidity level. Our findings highlight the potential benefits of implementing more targeted and personalized preventive initiatives for multimorbid patients.

KW - comorbidity

KW - epidemiology

KW - hip fracture

KW - infection

KW - interaction

KW - multimorbidity

UR - http://www.scopus.com/inward/record.url?scp=85219347164&partnerID=8YFLogxK

U2 - 10.2147/CLEP.S507252

DO - 10.2147/CLEP.S507252

M3 - Journal article

C2 - 40027399

AN - SCOPUS:85219347164

SN - 1179-1349

VL - 17

SP - 167

EP - 176

JO - Clinical epidemiology

JF - Clinical epidemiology

ER -

Interaction Between Multimorbidity and Hip Fracture Surgery Leads to Excess Risk of Infection: A Danish Registry-Based Cohort Study of 92,599 Patients With Hip Fracture

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Keywords

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