Reduction in the incidence of pneumonia in elderly patients after hip fracture surgery

Abstract

Hip fracture is an important health care issue in the elderly. Postoperative pulmonary complications occur in 4% of patients after hip fracture surgery. However, previous research is limited regarding pulmonary rehabilitation in this group. In this study, we present clinical evidence regarding the impact of a comprehensive pulmonary rehabilitation program in elderly hip fracture patients after hip surgery.We designed a nonrandomized, Quasi-experimental study, comparing 2 sequential time periods in the same center. Elderly patients (≥65 years) with a new hip fracture from February 1, 2014 to December 31, 2015 and who were willing to undergo a postoperative pulmonary rehabilitation program were enrolled. The pulmonary rehabilitation program started on January 1, 2015. Patients who refused rehabilitation or did not receive a surgical intervention were excluded. Patients received either standard care (standard care group) or standard care plus the postoperative rehabilitation program (intervention group).A total of 240 patients (163 women and 77 men) were enrolled, including 138 in the standard care group and 102 in the intervention group. The intervention group had a significantly lower incidence of pneumonia (6 patients, 5.9%) compared to the standard care group (19 patients, 13.9%). An age >80 years, cancer status, and not undergoing the postoperative pulmonary rehabilitation program were factors associated with a higher risk of pneumonia. In multivariate analysis, age >80 years, history of stroke/cancer, thrombocytopenia, and hyperglycemia (>200 mg/dL) were identified as risk factors for pneumonia.The incidence of pneumonia was lower in the elderly patients with hip fractures who received the postoperative pulmonary rehabilitation program after surgery. This is the first trial to demonstrate the effect of a postoperative pulmonary rehabilitation program in hip surgery patients.

<p>In-Hospital Postoperative Pneumonia Following Geriatric Intertrochanteric Fracture Surgery: Incidence and Risk Factors</p>

“…5 The optimum cutoff value for age related to IHPOP following geriatric intertrochanteric fracture surgery was 82 years by ROC curve analysis; age >82 years was an independent risk factor for the development IHPOP, and patients >82 years were 2.54 times more likely to develop IHPOP than those ≤82 years. In agreement with our findings, it was previously reported that patients >80 years old were more susceptible to developing POP after hip fractures 26 and that the incidence of POP increased with age, 27 being 2.3, 3.9, and 5.6 times higher in patients aged 60‒69, 70‒79, ≥80 years, respectively, than in those aged 50 years. Geriatric patients with intertrochanteric fractures are generally fragile and have at least one comorbidity.…”

<p>Gender and Low Albumin and Oxygen Levels are Risk Factors for Perioperative Pneumonia in Geriatric Hip Fracture Patients</p>

“…A study of 240 elderly hip fracture patients (≥65 years) demonstrated that patients over 80 years old had a higher risk of developing pneumonia. 9 A populationbased surveillance for community-acquired pneumonia found that the highest annual incidence of pneumonia was among patients ≥80 years. 10 Age, the number of comorbidities and chronic obstructive pulmonary disease were correlated with the occurrence of perioperative pneumonia after hip fracture in elderly patients.…”

<p>A Nomogram for Prediction of Postoperative Pneumonia Risk in Elderly Hip Fracture Patients</p>

“…Potential risk factors for postoperative pneumonia might include age, gender, BMI, hemoglobin, serum albumin, CRP, functional status, current smoking status, heart failure, COPD, time to surgery, operative time, blood transfusion and ASA classification. 12 , 13 , 20 – 23 In the present study, BMI, CRP, serum albumin, functional status and time to surgery were identified as independent risk factors for postoperative pneumonia ( Table 2 ). On the other hand, no significant differences were observed in the hemoglobin, creatinine, gender, anesthesia type, blood transfusion, current smoking status, current drinking status, operative time, history of hypertension, history of diabetes, history of circulatory disease and history of malignancy.…”