Ji Wan Kim, Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea, Phone: +82-2-3010-3530, Fax: +82-2-2045-4542, Email address:
J Nutr Health Aging. 2022;26(7):732-738. doi: 10.1007/s12603-022-1821-9.
The present study aimed to investigate the incidence of and risk factors for postoperative pneumonia and aspiration pneumonia after hip fracture surgery.
Retrospective cohort study from 2005 to 2021.
Asan Medical Center in Seoul, Republic of Korea.
A total 1,208 patients aged ≥ 65 years who underwent hip fracture surgery.
Postoperative pneumonia was defined as cases with new infiltration on chest x-ray or chest computed tomography (CT) after surgery or confirmed by a pulmonologist's consultation and diagnosis. Aspiration pneumonia was defined as: 1) radiologic findings of hospital-acquired pneumonia on chest radiographs or CT, medical record of aspiration pneumonia confirmed by a pulmonologist's consultation, and history of vomiting or aspiration, or 2) gravity-dependent opacity on chest CT when the history of vomiting or aspiration is ambiguous. Patient demographics, past medical history, pre-injury Koval score, Charlson Comorbidity Index (CCI), blood test results, length of hospital stay, and in-hospital mortality were evaluated. A comparison analysis and binary logistic regression were performed to identify the incidence and risk factors for postoperative pneumonia and aspiration pneumonia.
Postoperative pneumonia was diagnosed in 47 patients (3.9%), including 20 with aspiration pneumonia (1.7%). In the multivariate analysis, postoperative delirium (odds ratio [OR], 3.42; P < 0.001), American Society of Anesthesiologists (ASA) scores ≥ 3 (OR, 2.11; P = 0.021), and CCI (OR, 1.21; P = 0.013) were significant risk factors for postoperative pneumonia. Male sex (OR, 3.01; P = 0.017), postoperative delirium (OR, 3.16; P = 0.014), and preoperative serum albumin levels < 3.5 g/dL (OR, 7.00; P = 0.010) were significant risk factors for aspiration pneumonia.
ASA classification ≥ 3, higher CCI, and postoperative delirium were the risk factors for postoperative pneumonia. Male sex, postoperative delirium, and lower preoperative serum albumin level were the risk factors for aspiration pneumonia. Thus, physicians should pay attention to patients with the risk factors.
本研究旨在探讨髋部骨折手术后肺炎和吸入性肺炎的发生率及危险因素。
2005 年至 2021 年的回顾性队列研究。
韩国首尔的 Asan 医疗中心。
共纳入 1208 名年龄≥65 岁接受髋部骨折手术的患者。
术后肺炎定义为手术后胸部 X 线或胸部计算机断层扫描（CT）出现新浸润或经肺病专家会诊和诊断证实。吸入性肺炎定义为：1）胸部 X 线或 CT 显示医院获得性肺炎的放射学表现，经肺病专家会诊确认吸入性肺炎，且有呕吐或吸入史，或 2）当呕吐或吸入史不明确时，胸部 CT 显示重力依赖不透明。评估患者的人口统计学资料、既往病史、受伤前 Koval 评分、Charlson 合并症指数（CCI）、血液检查结果、住院时间和院内死亡率。进行比较分析和二项逻辑回归分析，以确定术后肺炎和吸入性肺炎的发生率和危险因素。
47 例（3.9%）患者诊断为术后肺炎，其中 20 例（1.7%）为吸入性肺炎。多变量分析显示，术后谵妄（比值比[OR]，3.42；P<0.001）、美国麻醉医师协会（ASA）评分≥3（OR，2.11；P=0.021）和 CCI（OR，1.21；P=0.013）是术后肺炎的显著危险因素。男性（OR，3.01；P=0.017）、术后谵妄（OR，3.16；P=0.014）和术前血清白蛋白水平<3.5 g/dL（OR，7.00；P=0.010）是吸入性肺炎的显著危险因素。
ASA 分级≥3、CCI 较高和术后谵妄是术后肺炎的危险因素。男性、术后谵妄和术前血清白蛋白水平较低是吸入性肺炎的危险因素。因此，医生应关注具有这些危险因素的患者。
