Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery: a prospective cohort study

Lv, Houchen; Yin, Pengbin; Long, Anhua; Yuan, Guandou; Zhao, Zhe; Li, J.; Zhang, L.; Tang, Peifu

doi:10.1007/s00198-016-3624-5

Cited by 88 publications

(138 citation statements)

References 38 publications

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“…Similarly, Song et al [49] performed a prospective study on 111 TKA patients who had a postoperative pneumonia incidence of 14.4%. Lv et al [50] performed a retrospective study that included 1,429 patients who underwent hip fracture surgery, and had a 4.9% of incidence of postoperative pneumonia. Bohl et al [51] retrospectively reviewed 11,353 patients who underwent anterior cervical decompression and fusion, and found postoperative pneumonia had an incidence rate of 0.45%.…”

Section: Resultsmentioning

confidence: 99%

The Epidemiology and Risk Factors for Postoperative Pneumonia

et al. 2017

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Postoperative pneumonia is a common complication of surgery, and is associated with marked morbidity and mortality. Despite advances in surgical and anesthetic technique, it persists as a frequent postoperative complication. Many studies have aimed to assess its burden, as well as associated risk factors. However, this complication varies among the different surgical specialties, and there is a paucity of reports that comprehensively evaluate this complication. Therefore, the purpose of this study was to review the epidemiology and risk factors of postoperative pneumonia in the setting of: 1) general surgery; 2) cardiothoracic surgery; 3) orthopedic and spine surgery; and 4) head and neck surgery.

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Section: Resultsmentioning

confidence: 99%

The Epidemiology and Risk Factors for Postoperative Pneumonia

et al. 2017

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“…In previous studies, several variables, including male sex, ASA classification, dehydration and stroke, were identified as risk factors of aspiration pneumonia and other complications. In the current study, patients with aspiration pneumonia were more likely to be male, had higher ASA scores, and showed a greater frequency of dehydration and stroke; however, these differences were not statistically significant, except for the percentage of patients with an ASA score of ≥3.…”

Section: Discussionmentioning

confidence: 99%

“…Among older patients with hip fractures, pneumonia is the most common complication . It is associated with an increased risk of mortality in older hip fracture patients, and its risk factors have been identified …”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] It is associated with an increased risk of mortality in older hip fracture patients, and its risk factors have been identified. 11,12 Dysphagia or an impaired swallowing function is noted among frail older patients, owing to declining brain function, decreased muscle mass and elasticity of connective tissue. [13][14][15] The decreased efficacy of swallowing in patients with dysphagia can cause aspiration and, consequently, aspiration pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and prognostic implications of aspiration pneumonia in older hip fracture patients: A multicenter retrospective analysis

Byun

Shon

Kim

et al. 2018

Geriatrics Gerontology Int

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Aim The present study aimed to investigate the risk factors and prognostic implications of aspiration pneumonia in older hip fracture patients. Methods A total of 394 female and 125 male hip fracture patients aged ≥60 years who underwent surgery between 2015 and 2018 were retrospectively analyzed. To identify risk factors of aspiration pneumonia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of aspiration and factors associated with surgery were compared between the aspiration pneumonia group and the control group. Regression analysis was also carried out. To assess the prognostic implications of aspiration pneumonia, hospital stay, frequency of the intensive care unit admission and in‐hospital mortality rates were compared between groups. Results Aspiration pneumonia was diagnosed in 8.8% of the hip fracture patients. Increased age, low body mass index, malnutrition, longer duration of surgery and delayed surgery were identified as risk factors of aspiration pneumonia. Regarding prognostic implications, hospital stay, the frequency of intensive care unit care and in‐hospital mortality rates were significantly higher in the aspiration pneumonia group (P < 0.001, <0.001 and 0.001, respectively). Conclusions Older hip fracture patients with aspiration pneumonia showed worse prognostic outcome compared with patients without aspiration pneumonia. Longer duration of surgery and delayed surgery, as well as patient characteristics including increased age, low body mass index and malnutrition were identified as risk factors for aspiration pneumonia. Therefore, surgeons should try to reduce the operation time and the time interval between injury and surgery when treating older patients for hip fractures. Geriatr Gerontol Int 2019; 19: 119–123.

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“…Pneumonia is also known to be a devastating complication after hip fracture surgery, which can also be life-threatening when correlative respiratory and circulatory failure was induced subsequently, and is especially risky to elderly patients who are more easily affected by the impactions of trauma and immobilization after fractures and surgeries. The reported incidence of pneumonia in elderly patients with a hip fracture was 1.2% preoperatively [22] and approximately 4% ~ 5% postoperatively according to recent literatures [14,15,21]. Although the overall incidence was not alarmingly great, it was found that patients who developed pneumonia would have a higher readmission rate, a higher rate of sepsis, and a higher mortality rate [15].…”

Section: Discussionmentioning

confidence: 99%

Postoperative pneumonia in geriatric patients with a hip fracture: incidence, risk factors and a predictive nomogram

Zhang

Duan

Tong

et al. 2020

Preprint

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Background : To evaluate the incidence and risk factors of postoperative pneumonia (POP) in geriatric patients with a hip fracture after surgery, to design a predictive nomogram and to validate the accuracy of the nomogram. Methods : We retrospectively studied 1285 surgical-treated geriatric patients with a hip fracture from April 2010 to April 2018. Surgical treatment was performed on the patients of this study. The procedure methods were classified as: total hip arthroplasty, hemiarthroplasty, percutaneous fixation, intramedullary nail fixation and plate/screw fixation. The primary interest of end point of this study is the development of POP during the postoperative period. The postoperative period in this study was defined as the time from 24 hours after surgery to discharge. The diagnostic criteria for pneumonia were set according to the guidelines built by the Infectious Diseases Society of America and the American Thoracic Society (Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia, 2005). Potential variables for developing POP were identified using logistic regression analyses initially and were further selected via the method of LASSO. Then the independent risk factors were identified by multivariable regression analyses. A predictive nomogram was built based on the multiple regression model, and the calibration abilities of the nomogram was measured by Harrel C-index, calibration plot and Hosmer-Lemeshow test respectively. Decision curve analysis was carried out to assess the net benefit due to threshold probability and an on-line questionnaire survey was conducted among the clinicians to assess the applicability of the nomogram coherently. Results: Of the 1285 patients, 70 (5.4%) developed POP. COPD, number of comorbidities, ASA classification > 2, preoperative dependent functional status and cognitive impairment were identified as independent risk factors of POP. The nomogram built based on the results showed good accordance between the predicted probabilities and the observed frequency. The decision curve analysis confirmed the clinical utility of the nomogram when the threshold probabilities were between 5% and 65% due to the net benefit, while the results of on-line questionnaire among 200 clinicians showed that 91.5% of the participants had a mental shreshold of intervention between 5-50%. Conclusion: 1. COPD, number of comorbidities, ASA classification > 2, preoperative dependent functional status and cognitive impairment were independent risk factors for POP. 2. The nomogram built in this study has a good accordance between the predictive risk and the observational incidence. The results of decision curve and questionnaire among clinicians show well applicability of the nomogram.

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Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery: a prospective cohort study

Abstract: Intrinsic factors and major clinical interventions were all important risk factors of POP in patients after hip fracture surgery. Targeted preventive measures to mitigate the above risk factors may help in reducing the incidence of POP.

Cited by 88 publications

References 38 publications

The Epidemiology and Risk Factors for Postoperative Pneumonia

The Epidemiology and Risk Factors for Postoperative Pneumonia

Risk factors and prognostic implications of aspiration pneumonia in older hip fracture patients: A multicenter retrospective analysis

Postoperative pneumonia in geriatric patients with a hip fracture: incidence, risk factors and a predictive nomogram

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