Surgery and risk of sporadic Creutzfeldt-Jakob disease in Denmark and Sweden: registry-based case-control studies.
BACKGROUND
Epidemiologic evidence of surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD) remains controversial.


METHODS
From Danish and Swedish registries we selected 167 definite and probable sCJD cases (with onset between 1987 and 2003) and 3,059 controls (835 age-, sex-, and residence-matched, and 2,224 unmatched). Independent of case/control status, surgical histories were obtained from National Hospital Discharge Registries. Surgical procedures were categorized by body system group and lag time to onset of sCJD. Exposure frequencies were compared using logistic regression.


RESULTS
A history of any major surgery, conducted >/=20 years before sCJD onset, was more common in cases than both matched (OR = 2.44, 95% CI = 1.46-4.07) and unmatched controls (OR = 2.25, 95% CI = 1.48-3.44). This observation was corroborated by a linear increase in risk per surgical discharge (OR = 1.57, 95% CI = 1.13-2.18; OR = 1.50, 95% CI = 1.18-1.91). Surgery of various body systems, including peripheral vessels, digestive system and spleen, and female genital organs, was significantly associated with increased sCJD risk.


CONCLUSIONS
A variety of major surgical procedures constitute a risk factor for sCJD following an incubation period of many years. A considerable number of sCJD cases may originate from health care-related accidental transmission.
Department of Applied Epidemiology, National Center for Epidemiology, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain.
Ignacio
I
Mahillo-Fernandez
Jesús
J
de Pedro-Cuesta
Maria José
MJ
Bleda
Mabel
M
Cruz
Kåre
K
Mølbak
Henning
H
Laursen
Gerhard
G
Falkenhorst
Pablo
P
Martínez-Martín
Ake
A
Siden
D016022:Case-Control Studies; D007562:Creutzfeldt-Jakob Syndrome / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery* / Q000635:transmission; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D017096:Prion Diseases / Q000453:epidemiology / Q000601:surgery; D012016:Reference Values; D012042:Registries; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000706:statistics & numerical data; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D065227:Transfusion Reaction