Postoperative pulmonary complications (PPCs) are common in geriatric patients with hip fractures and are associated with increased morbidity and mortality. Bedside lung ultrasonography may improve perioperative pulmonary risk stratification. This study aimed to develop and validate a nomogram incorporating lung ultrasonography findings, diaphragmatic mobility, and clinical parameters to predict PPCs in geriatric patients with hip fractures. This observational study included 786 geriatric patients with hip fractures undergoing surgery; patients were divided into a training cohort ( n = 594) and a validation cohort ( n = 192). Lung ultrasonography score and diaphragmatic mobility were assessed at the bedside one day before surgery. All patients received general anesthesia combined with a regional block and were followed for 2 weeks postoperatively for the occurrence of PPCs. Independent predictors were identified using logistic regression, and a nomogram was constructed. Model performance was evaluated using receiver operating characteristic analysis, calibration curves, and decision curve analysis. PPCs occurred in 32.84% (246/749) of patients. Nine independent variables were incorporated in the nomogram: American Society of Anesthesiologists physical status class, functional dependence, chronic obstructive pulmonary disease, lung ultrasonography score, diaphragmatic mobility, recent respiratory infection, hypoalbuminemia, anemia, and elevated N-terminal fragment of the pro–brain natriuretic peptide level. The model demonstrated strong discrimination, with an area under the curve of 0.897 (95% confidence interval, 0.870–0.924), good calibration, and favorable clinical utility. In addition, the nomogram outperformed the ARISCAT in the overall cohort. A nomogram incorporating bedside ultrasonography and clinical parameters demonstrated favorable predictive performance for PPCs in geriatric patients with hip fractures. This tool may provide supplementary information for perioperative risk stratification and aid in the development of targeted preventive strategies in clinical practice.
Yang et al. (Tue,) studied this question.