<p>Postoperative Physical Therapy to Prevent Hospital-acquired Pneumonia in Patients Over 80 Years Undergoing Hip Fracture Surgery—A Quasi-experimental Study</p>

Abstract

Background Hip fracture requiring surgical fixation is a common condition with high mortality and morbidity in the geriatric population. The patients are usually frail, and vulnerable to postoperative complications and delayed recovery. Few studies have investigated physical therapy methods to prevent hospital-acquired pneumonia (HAP) after hip fracture surgery. Objective To explore whether an intensified physical therapy regimen can prevent HAP and reduce hospital length of stay in patients aged 80 and older, following hip fracture surgery. Patients and Methods The inclusion criterion was patients aged 80 or older who had undergone hip fracture surgery at Örebro University Hospital, Sweden during eight months in 2015–2016 (the “physical therapy group”) (n=69). The study has a quasi-experimental design with a historical control group (n=64) who had received routine physical therapy treatment. The physical therapy group received intensified postoperative physical therapy treatment, which included daily supervised early mobilization and coached deep breathing exercises with positive expiratory pressure (PEP). The patients were instructed to take deep breaths, and then exhale through the PEP-valve in three sessions of 10 deep breaths, at least four times daily. Early mobilization to a sitting position and walking was advised as soon as possible after surgery. Results There was a significantly lower incidence of HAP in the physical therapy group; 2/69 (3%, 95%CI: 1– 10) compared to the historical control group 13/64 (20%, 95%CI: 12–32%) ( p =0.002). Patients in the physical therapy group had a significantly shorter length of stay than the control group (10.6±4 vs 13.4±9 days, p =0.022). Conclusion Intensified physical therapy treatment after hip fracture surgery may be of benefit to reduce the incidence of HAP in patients over 80 years; however, the results need to be confirmed in randomized controlled trials.

Implementation of a pneumonia prevention protocol to decrease the incidence of postoperative pneumonia in patients after hip fracture surgery

“…One year after hip fracture surgery, one-third of patients do not regain their pre-injury ambulation status or their level of functioning in activi- [ 10 , 11 ]. Moreover, in the search for solutions for more effective prevention protocols to decrease the incidence of postoperative pneumonia, several studies have shown beneficial effects of an oral hygiene protocol [10][11][12][13][14][15][16] .…”

Debilitating Fracture Hampering the Regular Chores of an 80-Year-Old Female and the Post-operative Rehabilitation for the Same: A Case Report

“…According to Stahl and Westerdahl, people over 80 may benefit from more intensive physiotherapy after a hip fracture is surgically repaired. Intensive physiotherapy can be given in terms of early mobilization, strengthening of lower limbs, bedside exercises, and breathing exercises [12].…”

Implementation of a Multidisciplinary “Code Hip” Protocol is Associated with Decreased Time to Surgery and Improved Patient Outcomes

“…They noted that, compared to the standard population, patients with a geriatric hip fracture demonstrated a functional decline generally 3 times faster than those of the control population. Prior studies have demonstrated the role that post-operative mobilization has on patient outcomes, such as that the inability to mobilize is associated with increased rates of pneumonia and hospital length of stay, 22 and is a key measure in the ability to recover functional independence and the patient's prior level of function. [23][24][25][26][27][28][29] Previous data from our institution demonstrated that ambulating greater than 5 feet within 72 hours was associated with a significantly decreased rate of post-operative morbidity and mortality.…”