Postoperative pneumonia in geriatric patients with a hip fracture: incidence, risk factors and a predictive nomogram

Abstract

Background : To evaluate the incidence and risk factors of postoperative pneumonia (POP) in geriatric patients with a hip fracture after surgery, to design a predictive nomogram and to validate the accuracy of the nomogram. Methods : We retrospectively studied 1285 surgical-treated geriatric patients with a hip fracture from April 2010 to April 2018. Surgical treatment was performed on the patients of this study. The procedure methods were classified as: total hip arthroplasty, hemiarthroplasty, percutaneous fixation, intramedullary nail fixation and plate/screw fixation. The primary interest of end point of this study is the development of POP during the postoperative period. The postoperative period in this study was defined as the time from 24 hours after surgery to discharge. The diagnostic criteria for pneumonia were set according to the guidelines built by the Infectious Diseases Society of America and the American Thoracic Society (Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia, 2005). Potential variables for developing POP were identified using logistic regression analyses initially and were further selected via the method of LASSO. Then the independent risk factors were identified by multivariable regression analyses. A predictive nomogram was built based on the multiple regression model, and the calibration abilities of the nomogram was measured by Harrel C-index, calibration plot and Hosmer-Lemeshow test respectively. Decision curve analysis was carried out to assess the net benefit due to threshold probability and an on-line questionnaire survey was conducted among the clinicians to assess the applicability of the nomogram coherently. Results: Of the 1285 patients, 70 (5.4%) developed POP. COPD, number of comorbidities, ASA classification > 2, preoperative dependent functional status and cognitive impairment were identified as independent risk factors of POP. The nomogram built based on the results showed good accordance between the predicted probabilities and the observed frequency. The decision curve analysis confirmed the clinical utility of the nomogram when the threshold probabilities were between 5% and 65% due to the net benefit, while the results of on-line questionnaire among 200 clinicians showed that 91.5% of the participants had a mental shreshold of intervention between 5-50%. Conclusion: 1. COPD, number of comorbidities, ASA classification > 2, preoperative dependent functional status and cognitive impairment were independent risk factors for POP. 2. The nomogram built in this study has a good accordance between the predictive risk and the observational incidence. The results of decision curve and questionnaire among clinicians show well applicability of the nomogram.

What are Risk Factors of Postoperative Pneumonia in Geriatric Individuals after Hip Fracture Surgery: A Systematic Review and Meta‐Analysis

“…2b). However, the I 2 value for five HQ studies 5,7,9,11,13 decreased to 0%, and the significance remained unchanged (OR = 1.66, 95% CI: 1.30-2.13, P < 0.0001), indicating the reliability of the result was (Fig. S1b).…”

“…Nine case-control studies [5][6][7][8][9][10][11][12][13]20 and one prospective cohort study 4 involving 12,084 patients were included in the metaanalysis, and 6.7% (809) of the patients developed POP. Seven of the 10 included studies were conducted in China.…”

“…Seven of the 10 included studies were conducted in China. In nine of the 10 studies, [4][5][6][8][9][10][11][12][13] the average or median age of the participants was >70 years. In the one other study, the patient distribution across different age groups were reported rather than the average age; however, age >65 years was one of the inclusion criteria.…”

“…Early surgery is recommended for such patients 2 . Postoperative pneumonia (POP) is the commonest postoperative complication, with an incidence of 3.5%–15.2%, ranking second to delirium 3–13 . Negative outcomes associated with POP included prolonged hospital length of stay, more frequent intensive care unit (ICU) stays, and a higher rate of sepsis, readmission, and mortality 14–16 .…”

“…2 Postoperative pneumonia (POP) is the commonest postoperative complication, with an incidence of 3.5%-15.2%, ranking second to delirium. [3][4][5][6][7][8][9][10][11][12][13] Negative outcomes associated with POP included prolonged hospital length of stay, more frequent intensive care unit (ICU) stays, and a higher rate of sepsis, readmission, and mortality. [14][15][16] The 30-day mortality rate for elderly patients who develop POP after hip fracture surgery was 27%-43%.…”