Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Joint Center, Inbone Hospital, Paju-si, Gyeonggi-do, South Korea.
BMC Musculoskelet Disord. 2022 Jun 8;23(1):553. doi: 10.1186/s12891-022-05497-1.
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.
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.
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.
Patients with the aforementioned risk factors should be identified preoperatively, and related prophylaxis strategies should be implemented to prevent POP following hip fracture surgery.
术后肺炎（POP）是髋部骨折手术后经常发生的一种破坏性并发症。本研究旨在定量和全面总结髋部骨折手术后 POP 的危险因素。
系统检索 PubMed、Embase 和 Cochrane Library 中评估髋部骨折手术后 POP 危险因素的研究。计算有和无 POP 患者之间的合并优势比（OR）和标准化均数差（SMD）。使用纽卡斯尔-渥太华量表评估证据。
纳入了 10 项研究，共 37130 例髋部骨折患者。POP 发生在 1768 例患者中，累积发生率为 7.8%（95%置信区间 [CI]：0.061-0.094）。年龄较大（SMD：0.50，95%CI：0.10-0.90）、男性（OR：1.50，95%CI：1.12-2.01）、美国麻醉医师协会身体状况评分≥3（OR：3.17，95%CI：1.25-8.05）、慢性阻塞性肺疾病（OR：2.05，95%CI：1.43-2.94）、冠心病（OR：1.82，95%CI：1.27-2.60）、心律失常（OR：1.49，95%CI：1.04-2.15）、充血性心力衰竭（OR：1.41，95%CI：1.14-1.75）、慢性肾脏病（OR：2.09，95%CI：1.28-3.41）和脑血管意外（OR：2.14，95%CI：1.60-2.85）是 POP 的危险因素。血红蛋白（SMD：-0.14，95%CI：-0.25 至 -0.03）、白蛋白（SMD：-0.97，95%CI：-1.54-0.41）、血尿素氮（SMD：0.20，95%CI：0.03-0.37）、丙氨酸氨基转移酶（SMD：0.27，95%CI：0.10-0.44）、动脉血氧分压（SMD：-0.49，95%CI：-0.71-0.27）、受伤至手术时间（SMD：0.13，95%CI：0.08-0.17）和 48 小时内手术（OR：3.74，95%CI：2.40-5.85）与 POP 的发生相关。
术前应识别出具有上述危险因素的患者，并实施相关预防策略，以预防髋部骨折手术后 POP 的发生。
