Risk stratification system and visualized dynamic nomogram constructed for predicting postoperative pneumonia in geriatric patients with hip fracture.

BACKGROUND

Hip fracture is a common and serious injury in older adults, with an increasing incidence as the population ages. Postoperative pneumonia (POP) is a common complication after hip fracture surgery, and is associated with increased mortality, morbidity, and length of hospital stay. The purpose of this study was to develop and validate a nomogram to predict the risk of POP in geriatric patients with hip fracture.

METHODS

We conducted a retrospective cohort study of geriatric patients who underwent hip fracture surgery in our hospital between Feb 2015 and Feb 2024. The cohort was randomly divided into training (n = 908) and validation (n = 388) sets. We used least absolute shrinkage and selection operator (LASSO) regression and logistic regression to identify independent risk factors for POP in the training set and constructed a nomogram using these predictors. The performance of the nomogram was evaluated by the C-index, Receiver Operating Characteristic (ROC) analysis, calibration plots, and decision curve analysis.

RESULTS

A total of 1296 patients were included in the study. The incidence of POP was 9.1%. The nomogram included the following variables: age, sex, Chronic Obstructive Pulmonary Disease (COPD), postoperative Intensive Care Unit (ICU), American Society of Anesthesiologists (ASA) classification, blood glucose, album. The nomogram for predicting POP achieved an area under the curve (AUC) of 0.874 (training set) and 0.840 (validation set). Furthermore, C-index, calibration plots and decision curve analysis demonstrated the adequate performance of the nomogram in both the training and validation sets.

CONCLUSIONS

The nomogram is a well-calibrated and discriminative tool that can be used to predict the risk of POP in geriatric patients with hip fracture. The nomogram may be useful for identifying patients who may benefit from preventive measures.