The Time-Effect Relationship between Time to Surgery and In-Hospital Postoperative Pneumonia in Older Patients with Hip Fracture

Xinqun Cheng; Song Liu; Jincheng Yan; Lin Wang; Xiang Lei; Haifeng Wu; Yanbin Zhu; Yingze Zhang

doi:10.1159/000535446

The Time-Effect Relationship between Time to Surgery and In-Hospital Postoperative Pneumonia in Older Patients with Hip Fracture

Gerontology. 2024;70(2):155-164. doi: 10.1159/000535446. Epub 2023 Nov 26.

Authors

Xinqun Cheng^{1

2}, Song Liu^{1

2}, Jincheng Yan^{1

2}, Lin Wang^{1

2}, Xiang Lei¹, Haifeng Wu¹, Yanbin Zhu^{1

2}, Yingze Zhang^{1

2}

Affiliations

¹ Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China.
² Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.

PMID: 38008089
DOI: 10.1159/000535446

Abstract

Introduction: Pneumonia is a common and devastating complication following hip fracture surgery in older patients. Time to surgery is a potentially modifiable factor associated with improved prognosis, and we aim to quantify the time-effect relationship between time to surgery and in-hospital postoperative pneumonia (IHPOP) and identify the effect of delayed surgery on the risk of IHPOP.

Methods: We analyzed clinical data of older hip fracture patients (≥60 years) undergoing surgical treatments at a tertiary referral trauma center between 2015 and 2020. Restricted cubic spline (RCS) was used to fit the time-effect relationship between time to surgery and IHPOP. Based on the results of RCS, we divided patients into two groups of "early surgery" and "delayed surgery." A 1:1 propensity score matching (PSM) analysis and multivariate conditional logistic regression analysis were performed to minimize the selection bias and determine the association magnitude. Subgroup analysis was conducted to assess potential interaction effects between delayed surgery and common risk factors for IHPOP.

Results: 3,118 eligible patients were included. The RCS curve showed an inverse S-shape trend and the relative risk of IHPOP decreased in the range of days 2-3 and increased on day 1 and day 3 or more post-injury, with the lowest point on day 3. PSM yielded 1,870 matched patients and delayed surgery (>3 days) was identified to be independently associated with IHPOP (relative ratio, 1.66; 95% confidence interval, 1.12-2.46; p value, 0.011). We observed positive interaction effects between delayed surgery and age of 80 years or more, female gender, COPD, heart disease, ASA score ≥3, anemia, and hypoproteinemia.

Conclusion: The relative risk of IHPOP decreased in the range of 2-3 days and increased on day 1 and day 3 or more post-injury. Delayed surgery (>3 days) was identified to be independently associated with a 1.66-fold increased risk of IHPOP.

Keywords: Delayed surgery; Hip fracture; In-hospital postoperative pneumonia; Older patients; Time to surgery.

MeSH terms

Aged
Aged, 80 and over
Female
Hip Fractures* / complications
Hip Fractures* / surgery
Hospitals
Humans
Pneumonia* / complications
Pneumonia* / etiology
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Risk Factors