Study shows surprising decreased surgical infection risk after age 65

Contrary to what you might think, advanced age does not increase the risk of surgical-site infections, according to a large long-term study reported in the April 1 issue of The Journal of Infectious Diseases, now available online. The study, which involved prospectively collected data on thousands of patients in multiple hospitals undergoing various surgical procedures, found that the infection risk increased by about 1 percent per year between the ages of 17 to 65 years but then decreased by about 1 percent per year after age 65; indeed, there were no surgical site infections in patients who were older than age 95.

The explanation for these surprising findings is unknown, but the possibilities may include a tendency by physicians to avoid surgery in frail elderly patients and, conversely, a "hardy survivor" effect, in which a protective genetic makeup may enable elderly patients to withstand the rigors of surgery and its complications.

Keith S. Kaye, MD, MPH, and colleagues at Duke University Medical Center and Durham Veterans Affairs Medical Center studied 144,485 patients over age 16 years with no pre-existing surgical-site infections who were admitted for surgery to 11 hospitals in the southeastern United States between Feb. 1, 1991 and July 31, 2002; the most common surgical procedures were orthopedic (42 percent), gastrointestinal (13 percent), obstetric/gynecologic (11 percent), or cardiothoracic (10 percent). Of the 144,485 patients studied, surgical-site infections developed in 1,684 (1.2 percent), with gastrointestinal procedures (3.1 percent), cardiothoracic procedures (2.3 percent), and vascular procedures (1.7 percent) having the highest rates

Between ages 17 and 65 years, the infection rate increased for each decade of increasing age, peaked at ages 65 to 74, and then decreased for each subsequent decade. This "inverted V" pattern was also seen when the investigators randomly divided the patients into two groups so that ag

Contact: Steve Baragona
Infectious Diseases Society of America

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