Preoperative risk factors for postoperative pneumonia following primary Total Hip and Knee Arthroplasty

Ally, Syeda Akila; Foy, Michael; Sood, Anshum; Gonzalez, Mark H.

doi:10.1016/j.jor.2021.08.008

Cited by 8 publications

(7 citation statements)

References 78 publications

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“…The data from this study, demonstrating increased odds of reoperation, deep and superficial SSI, and ED visits, aligns with the existing literature suggesting a relationship between chronic steroid use and subsequent surgical complications noted in gastrointestinal surgery, neurosurgery, orthopedics, and the specific area of spine surgery [7][8][9]12,13,19,38,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Kantar et al reported that patients using glucocorticoids for at least 30 days prior to surgery were at increased risk of postoperative venous thromboembolism; all-cause mortality; UTIs, sepsis; and wound, cardiac, and pulmonary complications [63].…”

Section: Discussionsupporting

confidence: 87%

Effects of Preoperative Glucocorticoid Use on Patients Undergoing Single-Level Lumbar Fusions: A Retrospective Propensity Score-Matched Registry Study

Stoltzfus,

Nguyen,

Freedman

et al. 2024

Cureus

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Objective Spinal fusions are gaining popularity as a means of treating spinal deformity and instability from a range of pathologies. The prevalence of glucocorticoid use has also increased in recent decades, and their systemic effects are well-documented. Although commonly used in the preoperative period, the effects of steroids on outcomes among patients undergoing spinal fusions are inadequately described. This study compares the odds of developing complications among patients who underwent single-level lumbar fusions with and without preoperative glucocorticoid use in hopes of establishing more evidence-based parameters for guiding preoperative steroid use. Methods The TriNetX multi-institutional electronic health record database was used to perform a retrospective, propensity score-matched analysis of clinical outcomes of two cohorts of patients who underwent posterior or posterolateral single-level lumbar fusions with and without interbody fusion, those who used glucocorticoids for at least one week within a year of fusion and those who did not. The outcomes of interest were examined within 30 days of the operation and included death, reoperation, deep or superficial surgical site infection (SSI), pneumonia, reintubation, ventilator dependence, tracheostomy, acute kidney injury (AKI), renal insufficiency, pulmonary embolism (PE) or deep venous thrombosis (DVT), urinary tract infection (UTI), emergency department (ED) visit, sepsis, and myocardial infarction (MI). Results The odds of developing pneumonia within 30 days of spinal fusion in the cohort that used glucocorticoids within one year of operation compared to the cohort without glucocorticoid use was 0.67 (p≤0.001, 95% CI: 0.59-0.69). The odds of requiring a tracheostomy within 30 days of spinal fusion in the cohort that used glucocorticoids within one year of operation compared to the cohort without glucocorticoid use was 0.39 (p≤0.001, 95% CI: 0.26-0.60). The odds of reoperation, deep and superficial SSI, and ED visits within 30 days of operation were significantly higher for the same glucocorticoid-receiving cohort, with odds ratios of 1.4 (p=0.003, 95% CI: 1.11-1.65), 1.86 (p≤0.001, 95% CI: 1.31-2.63), 2.28 (p≤0.001, 95% CI: 1.57-3.31), and 1.25 (p≤0.001, 95% CI: 1.17-1.33), respectively. After propensity score-matching, there was no significant difference between the odds of death, DVT, PE, MI, UTI, AKI, sepsis, reintubation, and ventilator dependence between the two cohorts. Conclusion In support of much of the current literature regarding preoperative glucocorticoid use and rates of complications, patients who underwent a single-level lumbar fusion and have used glucocorticoids for at least a week within a year of operation experienced significantly higher odds of reoperation, deep and superficial SSI, and ED visits. However, these patients using glucocorticoids were also found to have lower odds of developing pneumonia, renal insufficiency, and tracheostomy requir...

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Section: Discussionsupporting

confidence: 87%

Effects of Preoperative Glucocorticoid Use on Patients Undergoing Single-Level Lumbar Fusions: A Retrospective Propensity Score-Matched Registry Study

Stoltzfus,

Nguyen,

Freedman

et al. 2024

Cureus

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“…Smoking‐induced POP accounts for the increased mortality in elderly patients with hip fractures 30 . Ally et al identified smoking as a risk factor for POP after THA and knee arthroplasty and reported that smoking cessation at least 4 weeks prior to surgery could markedly reduce the incidence of POP 31 . However, early surgery is currently recommended in elderly patients with hip fractures, and a prolonged preoperative waiting time is associated with poor prognosis 32 .…”

Section: Discussionmentioning

confidence: 99%

“… 30 Ally et al identified smoking as a risk factor for POP after THA and knee arthroplasty and reported that smoking cessation at least 4 weeks prior to surgery could markedly reduce the incidence of POP. 31 However, early surgery is currently recommended in elderly patients with hip fractures, and a prolonged preoperative waiting time is associated with poor prognosis. 32 The development of perioperative airway management strategies, particularly for patients who smoke, might help lower the incidence of POP; however, further research is warranted.…”

Section: Discussionmentioning

confidence: 99%

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

Gao

Zhang

Shi

et al. 2022

Orthopaedic Surgery

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Postoperative pneumonia (POP) is a common postoperative complication. Negative consequences 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. This meta-analysis aimed to assess the incidence and risk factors associated with POP after hip fracture surgery in elderly patients. PubMed, Web of Science, and Cochrane Library were searched (up to March 31, 2022). All studies on the risk factors for POP after hip fracture surgery in elderly patients, published in English, were reviewed. The qualities of the included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled, and a meta-analysis was performed. Ten studies, including 12,084 geriatric patients undergoing hip fracture surgery, were included. Of these 12,084 patients, POP occurred in 809 patients. The results indicated that age

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“…Advanced age and male sex have long been associated with adverse postoperative morbidities, including POP, in non-cardiac and orthopedic surgeries [ 20 – 23 ]. Airway inflammation and pneumonia increase with age because of swallowing and immune dysfunctions [ 24 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative pneumonia in patients undergoing hip fracture surgery: a systematic review and meta-analysis

Han

Kim²,

Shin

2022

BMC Musculoskelet Disord

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Background Postoperative pneumonia (POP) is a devastating complication that can frequently occur after hip fracture surgery. This study aimed to quantitatively and comprehensively summarize the risk factors for POP following hip fracture surgery. Methods PubMed, Embase, and Cochrane Library were systematically searched for studies assessing risk factors for POP following hip fracture surgery. The pooled odds ratio (OR) and standardized mean difference (SMD) between patients with and without POP were calculated. Evidence was assessed using the Newcastle–Ottawa scale. Results Ten studies including 37,130 patients with hip fractures were selected. POP occurred in 1768 cases with an accumulated incidence of 7.8% (95% confidence interval [CI]: 0.061–0.094). Advanced age (SMD: 0.50, 95% CI: 0.10–0.90), male sex (OR: 1.50, 95% CI: 1.12–2.01), American Society of Anesthesiologists physical status scale ≥3 (OR: 3.17, 95% CI: 1.25–8.05), chronic obstructive pulmonary disease (OR: 2.05, 95% CI: 1.43–2.94), coronary heart disease (OR: 1.82, 95% CI: 1.27–2.60), arrhythmia (OR: 1.49, 95% CI: 1.04–2.15), congestive heart failure (OR: 1.41, 95% CI: 1.14–1.75), chronic kidney disease (OR: 2.09, 95% CI: 1.28–3.41), and cerebrovascular accident (OR: 2.14, 95% CI: 1.60–2.85) were risk factors for POP. Hemoglobin (SMD: -0.14, 95% CI: − 0.25 to − 0.03), albumin (SMD: -0.97, 95% CI: − 1.54–-0.41), blood urea nitrogen (SMD: 0.20, 95% CI: 0.03–0.37), alanine aminotransferase (SMD: 0.27, 95% CI: 0.10–0.44), arterial oxygen pressure (SMD: -0.49, 95% CI: − 0.71–-0.27), time from injury to surgery (SMD: 0.13, 95% CI: 0.08–0.17), and surgery within 48 h (OR: 3.74, 95% CI: 2.40–5.85) were associated with the development of POP. Conclusion Patients with the aforementioned risk factors should be identified preoperatively, and related prophylaxis strategies should be implemented to prevent POP following hip fracture surgery.

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Preoperative risk factors for postoperative pneumonia following primary Total Hip and Knee Arthroplasty

Cited by 8 publications

References 78 publications

Effects of Preoperative Glucocorticoid Use on Patients Undergoing Single-Level Lumbar Fusions: A Retrospective Propensity Score-Matched Registry Study

Effects of Preoperative Glucocorticoid Use on Patients Undergoing Single-Level Lumbar Fusions: A Retrospective Propensity Score-Matched Registry Study

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

Risk factors for postoperative pneumonia in patients undergoing hip fracture surgery: a systematic review and meta-analysis

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