What is the clinical evidence from this study?

Study design: Cohort. Population: Hip fracture (n=3147). Intervention: General anesthesia vs. Local anesthesia. Primary outcome: Postoperative pneumonia (OR 1.61, 95% CI 1.15-2.27, p=0.006).

March 24, 2022Open Access

Incidence and risk factors for postoperative pneumonia following surgically treated hip fracture in geriatric patients: a retrospective cohort study

Key Result

In geriatric patients undergoing hip fracture surgery, the incidence of postoperative pneumonia was 5.8%, with general anesthesia (OR 1.61) and respiratory disease (OR 3.74) identified as significant independent risk factors.

Study Design

Type

Cohort (n=3,147)

Multicenter

Structured PICO

Population

3,147 geriatric patients who underwent surgery for hip fracture in a tertiary referral center between 2016 and 2020

Outcome

Development of postoperative pneumonia during hospitalization stay

In geriatric patients undergoing hip fracture surgery, postoperative pneumonia occurred in 5.8% of cases and was independently associated with older age, male sex, specific comorbidities, longer preoperative stay, and general anesthesia.

Main Result

Effect estimate: OR 1.61 (95% CI 1.15-2.27)

p-value: p=0.006

Limitations

Single-center retrospective study design may bias the accuracy of collected data
Postoperative pneumonia was only tracked during the hospitalization period, potentially underestimating complications
Generalizability to other settings requires further investigation due to the single-center tertiary referral trauma center design
Findings represent associative rather than causative relationships
Potential confounding effects remain an issue due to unmeasured or unquantifiable variables

Abstract

OBJECTIVE: Large sample investigations for risk factors for pneumonia in elderly patients after hip fracture surgeries are lacking. The purpose of this study is to determine the incidence and risk factors for postoperative pneumonia in geriatric patients following hip fracture operations. METHODS: A retrospective study of incidence and risk factors in a tertiary referral center between 2016 and 2020 was conducted. Geriatric patients who developed postoperative pneumonia after surgeries of hip fracture during hospitalization stay were defined as cases and those without as controls. Multivariate logistic regression model was used to evaluate risk factors for postoperative pneumonia. RESULTS: This study included 3147 patients, and 182 developed postoperative pneumonia, denoting the rate of 5.8%. In the multivariate analyses, age (OR 1.04; 95% CI 1.02-1.06), sex (males) (OR 2.27; 95% CI 1.64-3.13), respiratory disease (OR 3.74; 95% CI 2.32-6.04), heart disease (OR 1.68; 95% CI 1.14-2.47), cerebrovascular disease (OR 1.58; 95% CI 1.11-2.27), liver disease (OR 2.61; 95% CI 1.33-5.15), preoperative stay (OR 1.08; 95% CI 1.05-1.11) and general anesthesia (OR 1.61; 95% CI 1.15-2.27) were identified as independent risk factors for postoperative pneumonia. CONCLUSIONS: This study identified several risk factors for pneumonia in geriatric patients after hip fracture operations, providing a viable preventive strategy for optimizing clinical conditions for reduction of postoperative pneumonia.

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