Purpose: The in-hospital death rate in cases of hip fracture ranges from 6% to 10%. Pneumonia is a serious complication for hip fracture patients that contributes to longer hospital stays and higher mortality rates; however, the prevalence and risk factors are not well established. To address this issue, the present study investigated the incidence of and risk factors for in-hospital postoperative pneumonia (IHPOP) following geriatric intertrochanteric fracture surgery.
Patients and Methods: Information on 1495 geriatric patients (> 65 years) who underwent intertrochanteric fracture surgery at our hospital between October 2014 and December 2018 was extracted from a prospective hip fracture database and reviewed. Demographic information, clinical variables including surgical data, and preoperative laboratory indices that could potentially influence IHPOP were analyzed. Receiver operating characteristic curve analysis was performed and the optimum cutoff value for quantitative data was determined. Univariate and multivariate analyses were carried out to identify risk factors for IHPOP.
Results: The incidence of IHPOP following geriatric intertrochanteric fracture surgery was 3.5% (53/1495 cases). The multivariate analysis showed that age > 82 years (odds ratio [OR]=2.54, p=0.004), male sex (OR=2.13, p=0.017), chronic respiratory disease (OR=5.02, p< 0.001), liver disease (OR=3.39, p=0.037), urinary tract infection (OR=8.46, p=0.005), creatine kinase (CK) MB> 20 U/l (OR=2.31, p=0.020), B-type natriuretic peptide (BNP) ≥ 75 ng/l (OR=4.02, p=0.001), and d-dimer > 2.26 mg/l (OR=2.69, p=0.002) were independent risks factor for the incidence of IHPOP following geriatric intertrochanteric fracture surgery.
Conclusion: The incidence of IHPOP was 3.5% following geriatric intertrochanteric fracture surgery; age, male sex, chronic respiratory disease, liver disease, urinary tract infection, CKMB, BNP, and d-dimer were significant risk factors. Targeted preoperative management based on these factors could reduce the risk of IHPOP and mortality in these patients.
Keywords: intertrochanteric fracture, postoperative pneumonia, in-hospital complication, geriatric population, risk factor