title: Relationship between hospital infection and long-term mortality in general surgery: a prospective follow-up study.
abstract: A prospective study of 1431 patients admitted to a general surgery department were followed up for a median of 6.2 years after discharge (7679 person-years of follow-up). We collected information on underlying conditions, including severity of illness, and healthcare-related variables. Relative rates of death and their 95% confidence interval (CI) were estimated using person-years as the denominator. Multiple-risk factors adjusted for relative rates (RR) were obtained using Poisson regression analysis. There were 172 deaths during the follow-up period after hospital discharge (2/100 person-years). Follow-up was complete in 91% of the cohort. There were no important differences in demographic characteristics or risk factors between patients followed up and those lost to follow-up. The death rate in patients with any hospital-acquired infection was 5.3/100 person-years, and the relative rate was 3.07 (95% CI: 2.20-4.24). After adjusting for the main predictors of mortality, we found an effect modification by the presence of chronic disease (P = 0.01 for the product-term between hospital infection and the diagnosis of chronic diseases). Among patients without any underlying chronic disease, hospital-acquired infection was related to a significantly higher long-term mortality (RR = 2.47, 95% CI: 1.24-4.91). In these patients, surgical wound infection yielded a RR of mortality of 3.44 (95% CI: 1.63-7.27). Among patients with underlying chronic disease no association between hospital infection and long-term mortality was found. No evidence of an important modification of the relative rate along the follow-up period was observed. In conclusion surgical patients without chronic disease developing hospital-acquired infection have an increased risk of long-term mortality.
authors.affiliation: Department of General Surgery, General Hospital Ciudad de Jaén, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Cosano
authors.forename: M A
authors.initials: MA
authors.lastname: Martínez-González
authors.forename: M
authors.initials: M
authors.lastname: Medina-Cuadros
authors.forename: G
authors.initials: G
authors.lastname: Martínez-Gallego
authors.forename: S
authors.initials: S
authors.lastname: Palma
authors.forename: M
authors.initials: M
authors.lastname: Delgado-Rodríguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D016001:Confidence Intervals; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012720:Severity of Illness Index; D013030:Spain; D016019:Survival Analysis; D013997:Time Factors