Early Detection of Pneumonia with the Help of Dementia in Geriatric Hip Fracture Patients

Abstract

Objective To investigate the role of dementia in pneumonia among geriatric patients with hip fracture and further develop an algorithm for stratifying risk of developing postoperative pneumonia. Methods The algorithm was developed after retrospectively analyzing 1344 hip fracture patients in the National Clinical Research Center for Orthopedics, Sports Medicine, and Rehabilitation from 1992 to 2012. Twenty‐eight variables were analyzed for evaluating the ability to predict postoperative pneumonia. The validation of the algorithm was performed in the MIMIC‐III database after enrolling 235 patients. Results One thousand five hundred and seventy‐nine patients were enrolled, 4.69% patients had postoperative pneumonia in our hospital, and 17.02% suffered pneumonia in the MIMIC‐III database. Dementia patients had more postoperative pneumonia (12.68% vs 4.24%, P = 0.0075), as compared with patients without dementia. The algorithm included nine predictors: dementia, age, coronary heart disease, the American Society of Anesthesiologists score, surgical method, mechanical ventilation, anemia, hypoproteinemia, and high creatinine. Internal validation showed the algorithm with dementia could improve predictive performance, while external validation found the algorithm with or without dementia both had similar and good predictive ability. Conclusions The algorithm has the potential to be a pragmatic risk prediction tool to calculate risk of pneumonia in clinical practice and it may also be applicable in critically ill hip fracture patients with dementia.

Incidence and risk factors for postoperative nosocomial pneumonia in elderly patients with hip fractures: A single-center study

“…Another important factor might be that 15.8% of included patients were conservatively treated, also a well-established risk factor for various complications and adverse outcomes, including pneumonia and even morality (3,17). In contrast, in the study there the lowest incidence rate (4.7%) was reported, the lower proportion of smokers (4.4%, about 1/4 as ours) and relatively low proportion of femoral neck fracture, a substantial proportion of which requires arthroplasty, might contribute greatly (6).…”

“…and having chronic respiratory disease, simplification of procedure to admit and multidisciplinary intervention to achieve a fastest medical optimization might be more effective, e.g., setting of dedicated, organized and comprehensive orthogeriatric care wards (28). Greater surgical trauma meant the increased body inflammatory/ immune response, and the prolonged surgical duration and arthroplasty procedure (vs. osteosynthesis), undoubtedly, contributed predominantly to this effect (6,7). Despite the international guidelines recommending specific surgical procedure for different fracture patterns of hip fractures, taking age and systemic conditions into consideration, but that seemed more applicable for femoral neck fractures.…”

“…This strategy allows early mobility and initiation of postoperative exercises, and thus helps to prevent or reduce many complications that often occur after conservative treatments, e.g., deep venous thrombosis (DVT) of lower extremities, neuromuscular dysfunction or even mortality within early period (2,3). Despite that, postoperative nosocomial pneumonia, which would cause systemic dysfunction and even death, is prevalent in 4.7%-16.3% of elderly hip fracture patients (4)(5)(6)(7). Not only the direct adverse events, but also the great costs from prolonged hospitalization stay and re-admission to hospital constitute a substantial burden for patients and the public healthcare systems (4,8,9).…”

“…From the cost-effective point of view, to prevent is most favorable than to treat. Indeed, during the past decade, researchers have made substantial attempts to address the prevention, and numerous influential factors have been well established, e.g., male sex, advanced age, obesity, history of a chronic respiration disease, active smoking, undernutrition, greater comorbidity index (American Society of Anesthesiologists score ≥ III) or presence of a specific comorbidity or condition (diabetes, renal insufficiency, dementia, anemia, hypoalbuminemia, lower oxygen status), delay to surgery, surgical method (arthroplasty vs. osteosynthesis) and mechanical ventilation ( 4 , 6 , 8 , 10 – 12 ). However, some limitations should be noted, including but not limited to relatively small sample size, inadequate confounders for adjustment, and inaccuracy in data collection.…”

What are Risk Factors of Postoperative Pneumonia in Geriatric Individuals after Hip Fracture Surgery: A Systematic Review and Meta‐Analysis

“…Nine case‐control studies 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 20 and one prospective cohort study 4 involving 12,084 patients were included in the meta‐analysis, and 6.7% (809) of the patients developed POP. Seven of the 10 included studies were conducted in China.…”