Wang Junxiang, Yu Hui, Xu Xin, Guo Junfei
Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, 710054, People's Republic of China.
Xi'an Key Laboratory of Pathogenesis and Precision Treatment of Arthritis, Xi'an, Shanxi, 710054, People's Republic of China.
Clin Interv Aging. 2025 Aug 10;20:1205-1221. doi: 10.2147/CIA.S523802. eCollection 2025.
Postoperative pneumonia is a common and severe complication following hip fracture (HF) surgery in the elderly. Hypoalbuminemia, a marker of poor nutritional status and systemic inflammation, is widely recognized as a predictor of adverse outcomes. However, their bidirectional relationship in elderly HF patients remains underexplored.
This retrospective cohort study was conducted in China enrolling elderly patients (≥65 years) with HFs between Mar 2020 and Feb 2023. After predefined participants selection inclusion and exclusion criteria, 1661 surgically treated HF patients were included and analyzed utilizing multiple statistical models, including univariate logistic regression, Lasso regression, and Boruta algorithm for variable selection, while multivariate logistic regression and propensity score matching (PSM) for assess the bidirectional relationship between hypoalbuminemia and postoperative pneumonia. All participants' demographics, injury-related data, surgery-related data, perioperative complications, and two-year follow-up mortality rates were collected and compared.
A total of 1,661 patients were included, of whom 144 developed postoperative pneumonia (8.67%). Preoperative hypoalbuminemia was identified as an independent risk factor for postoperative pneumonia (OR: 7.96, 95% CI: 4.08-15.53, <0.001), while postoperative pneumonia itself was associated with an increased risk of developing hypoalbuminemia (OR: 2.34, 95% CI: 1.62-3.38, <0.001). PSM, as sensitivity analyses, further confirmed that postoperative pneumonia itself exacerbates hypoalbuminemia, creating a detrimental cycle. In addition, postoperative pneumonia significantly prolonged hospital stays, increased complication, and elevated mortality rates at 3 months to 2 years (OR: 1.83-3.43, all <0.05) follow-up period.
Preoperative hypoalbuminemia is a significant predictor of postoperative pneumonia in elderly patients with HFs, and postoperative pneumonia, in turn, exacerbates hypoalbuminemia, creating a deleterious cycle. Early nutritional assessment and intervention are essential in breaking this cycle and improving outcomes. These findings support the incorporation of routine nutritional screening and optimization into the preoperative care of elderly HF patients to reduce complications and enhance recovery.
术后肺炎是老年髋部骨折（HF）手术常见且严重的并发症。低白蛋白血症是营养状况差和全身炎症的标志物，被广泛认为是不良结局的预测指标。然而，老年HF患者中它们的双向关系仍未得到充分研究。
本回顾性队列研究在中国进行，纳入2020年3月至2023年2月期间年龄≥65岁的HF老年患者。在预先确定参与者的纳入和排除标准后，纳入1661例接受手术治疗的HF患者，并使用多种统计模型进行分析，包括单因素逻辑回归、Lasso回归和用于变量选择的Boruta算法，同时使用多因素逻辑回归和倾向评分匹配（PSM）来评估低白蛋白血症与术后肺炎之间的双向关系。收集并比较所有参与者的人口统计学数据、损伤相关数据、手术相关数据、围手术期并发症以及两年随访死亡率。
共纳入1661例患者，其中144例发生术后肺炎（8.67%）。术前低白蛋白血症被确定为术后肺炎的独立危险因素（OR：7.96，95%CI：4.08-15.53，<0.001），而术后肺炎本身与发生低白蛋白血症的风险增加相关（OR：2.34，95%CI：1.62-3.38，<0.001）。作为敏感性分析的PSM进一步证实，术后肺炎本身会加重低白蛋白血症，形成有害循环。此外，术后肺炎显著延长了住院时间，增加了并发症，并在3个月至2年的随访期内提高了死亡率（OR：1.83-3.43，均<0.05）。
术前低白蛋白血症是老年HF患者术后肺炎的重要预测指标，而术后肺炎反过来又会加重低白蛋白血症，形成有害循环。早期营养评估和干预对于打破这一循环和改善结局至关重要。这些发现支持将常规营养筛查和优化纳入老年HF患者的术前护理，以减少并发症并促进康复。
