Risk factors and prognostic implications of aspiration pneumonia in older hip fracture patients: A multicenter retrospective analysis

Byun, Seong‐Eun; Shon, Hyun-Chul; Kim, Ji Wan; Kim, Hyung Kyung; Sim, Yu Fan

doi:10.1111/ggi.13559

Cited by 40 publications

(62 citation statements)

References 30 publications

(80 reference statements)

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“…Mental-cognitive factors such as perception of reality disorders and impaired cognition were independently associated with pressure ulcers and aspiration pneumonia. These results corroborate those of previous inquiries that identified delirium as a risk factor for these AEs [33,40]. Within the psycho-emotional domain, fear and anxiety were risk factors for falls.…”

Section: Plos Onesupporting

confidence: 90%

“…Regarding age, older patients exhibit a higher risk of becoming frail, of presenting comorbidities and experiencing AEs during hospitalization, probably because of their increased care needs [ 11 , 26 , 32 , 33 ]. A systematic review identified co-morbidity, reduced functional ability and lower quality of care as important causative factors associated with AEs [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Care complexity individual factors associated with adverse events and in-hospital mortality

et al. 2020

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Introduction Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular

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Section: Plos Onesupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Care complexity individual factors associated with adverse events and in-hospital mortality

et al. 2020

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“…The risk factors for peri-operative pneumonia have been identified [19]. According to Seong-Eun et al, age, low body mass index, malnutrition, longer surgery duration and delayed surgery are risk factors for pneumonia [20]. Daniel et al proposed that the risk factors for pneumonia in geriatric patients undergoing surgery for hip fracture are male sex, elderly age, low body mass index and chronic obstructive pulmonary disease [21].…”

Section: Discussionmentioning

confidence: 99%

A clinical pathway for pre-operative screening of COVID-19 and its influence on clinical outcome in patients with traumatic fractures

Meng

Leng

Shan

et al. 2020

International Orthopaedics (SICOT)

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Purpose Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. The toughest issue traumatic orthopaedic surgeons are faced with is how to maintain a balance between adequate COVID-19 screening and timely surgery. In this study, we described our experience with pre-operative COVID-19 screening in patients with traumatic fractures. Furthermore, we analysed the clinical results of fracture patients undergoing confined or emergency surgery during the COVID-19 outbreak. Methods This was a case series study. Patients with traumatic fractures who were admitted to our hospital for surgery were enrolled in this study during the COVID-19 outbreak from March to April 2020. All patients were enrolled and managed using the standardized clinical pathway we designed for preoperative COVID-19 screening. Clinical, laboratory and outcome data were analysed. Results The average surgery waiting time from injury to surgery was 8.7 ± 3.4 days. The average waiting time from admission to surgery was 5.3 ± 2.8 days. These average waiting times were increased by 4.1 days and 2.0 days, respectively, compared with 2019 data. Cardiovascular complications, venous thromboembolism and pneumonia occurred in one, two and one patient, respectively. Three and two patients developed pre-operative and postoperative fevers, respectively. Conclusions We introduced a novel clinical pathway for pre-operatively screening of COVID-19 in traumatic orthopaedic patients. The delay in surgery caused by COVID-19 screening was minimized to a point at which reasonable and acceptable clinical outcomes were achieved. Doctors should pay more attention to perioperative complications, such as cardiovascular complications, venous thromboembolism, pneumonia and fever.

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“…Surgical treatments are commonly conducted to treat hip fractures, thus about 17,900 female older patients would possibly develop dysphagia after surgery, assuming the prevalence of developing dysphagia was 13%. In particular, dysphagia is a risk factor for aspiration pneumonia, whose reported prevalence after hip fracture surgery was 4.1~11.1% [30][31][32][33]. Aspiration pneumonia was associated with an increase in mortality [31], readmission rates, and sepsis [32].…”

Section: Discussionmentioning

confidence: 99%

Association of Sarcopenic Dysphagia with Underlying Sarcopenia Following Hip Fracture Surgery in Older Women

et al. 2020

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This study aimed to investigate the association between the development of dysphagia in patients with underlying sarcopenia and the prevalence of sarcopenic dysphagia in older patients following surgical treatment for hip fracture. Older female patients with hip fractures (n = 89) were studied. The data of skeletal muscle mass, hand-grip strength, and nutritional status were examined. The development of dysphagia postoperatively was graded using the Food Oral Intake Scale by a certified nurse in dysphagia nursing. The patients’ mean age was 85.9 ± 6.5 years. The prevalence of sarcopenia was 76.4% at baseline. Of the 89 patients, 11 (12.3%) and 12 (13.5%) had dysphagia by day 7 of hospitalization and at discharge, respectively. All patients who developed dysphagia had underlying sarcopenia. Lower skeletal muscle mass index (SMI) (<4.7 kg/m2) and grip strength (<8 kg) at baseline indicated a higher incidence of dysphagia on day 7 (p = 0.003 and Phi = 0.391) and at discharge (p = 0.001 and Phi = 0.448). Dysphagia developed after hip fracture surgery could be sarcopenic dysphagia, and worsening sarcopenia was a risk factor for dysphagia following hip fracture surgery. Clinicians and medical coworkers should become more aware of the risks of sarcopenic dysphagia. Early detection and preventive interventions for dysphagia should be emphasized.

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Risk factors and prognostic implications of aspiration pneumonia in older hip fracture patients: A multicenter retrospective analysis

Cited by 40 publications

References 30 publications

Care complexity individual factors associated with adverse events and in-hospital mortality

Care complexity individual factors associated with adverse events and in-hospital mortality

A clinical pathway for pre-operative screening of COVID-19 and its influence on clinical outcome in patients with traumatic fractures

Association of Sarcopenic Dysphagia with Underlying Sarcopenia Following Hip Fracture Surgery in Older Women

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