Prediction of Postoperative Pulmonary Complications in Geriatric Patients with Hip Fracture Using Lung Ultrasonography Score and Diaphragmatic Mobility

Purpose: Postoperative pulmonary complications (PPCs), common in geriatric patients with hip fractures, are associated with increased morbidity and mortality rates. Bedside ultrasonography may improve perioperative pulmonary risk stratification. This study aimed to evaluate the predictive value of the lung ultrasonography score (LUS) and diaphragmatic mobility (DM) for PPCs and identify the optimal index. Patients and Methods: This prospective observational study included 192 geriatric patients with hip fractures who underwent surgery. One day preoperatively, LUS and DM were assessed at bedside. All patients received general anesthesia combined with a regional block and were followed up for 30 days postoperatively for the occurrence of PPCs. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to evaluate predictive performance and adjust for confounders. Results: PPCs occurred in 28.64% (55/192) of the patients. LUS and DM exhibited moderate predictive efficacies for PPCs (LUS: AUC = 0.740, 95% CI: 0.653– 0.826; DM: AUC = 0.733, 95% CI: 0.655– 0.812). At a cutoff value of LUS > 5 cm, the negative predictive value reached 81.9%, and at a cutoff value of DM 5 and DM 5: adjusted OR = 6.363, 95% CI: 2.609– 15.515; P 5) and DM (DM < 3.7 cm) with ARISCAT significantly improved predictive performance (AUC = 0.851 with the integrated model vs. 0.684 with ARISCAT alone; DeLong’s P < 0.001). Conclusion: LUS and DM effectively predicted PPCs in geriatric patients with hip fractures. The integration of LUS and DM with ARISCAT markedly enhances predictive accuracy, suggesting that lung and diaphragmatic ultrasound may serve as useful bedside tools for perioperative respiratory risk assessment. Keywords: postoperative pulmonary complications, geriatric patients, hip fracture, ultrasonography