Study Finds High Incidence of Pulmonary Complications After Femur Fracture Surgery in Patients Aged 80 and Older

"The most prevalent complications were pleural effusion, pneumonia, and atelectasis, which contributed to longer hospital stays, increased oxygen needs, and a 14.3% mortality rate within 90 days. The study identified several key risk factors for pulmonary complications, including advanced age, chronic lung disease, and Parkinson's disease," the researchers reported.

As the population of older adults continues to grow, femur fractures and the associated surgeries are expected to rise. Although older patients are known to face a heightened risk of postoperative pulmonary complications, research specifically targeting those aged 80 and older remains limited. To address this gap, Jina Chai, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Gyeonggi-do, Republic of Korea, and colleagues aimed to investigate the incidence and risk factors of pulmonary complications following femur fracture surgery in patients aged 80 and above.

For this purpose, the researchers conducted a retrospective cohort study that included patients aged 80 years and older admitted to the Orthopedic Surgery Department for femur fracture surgery between 2020 and 2022.

The study aimed to assess the incidence and risk factors of postoperative pulmonary complications, which were defined as pneumonia, atelectasis, pulmonary edema, pleural effusion, and venous thromboembolism (VTE). Additionally, the researchers examined the risk factors for respiratory failure and 90-day mortality, utilizing logistic regression models to analyze the data.

The study revealed the following findings:

• Study Participants: The study included 479 patients, with a mean age of 86.0 years, and 78.5% were women.

• Postoperative Pulmonary Complications:

• 11.7% of patients developed postoperative pulmonary complications.

• The most common complications were pleural effusion (4.4%), followed by pneumonia and atelectasis.

• The incidence of venous thromboembolism (VTE) was 1.5%.

• Impact of Pulmonary Complications:

• Patients with pulmonary complications had significantly longer hospital stays (14 days vs 10 days, p < 0.001).

• A greater proportion of these patients required oxygen supplementation (71.4% vs 31.4%).

• Higher 90-day mortality was observed in patients with pulmonary complications (14.3% vs 5.9%).

• Risk Factors for Pulmonary Complications:

• Age, chronic lung disease, and Parkinson’s disease were significant risk factors for pulmonary complications.

 • Risk Factors for Respiratory Failure:

• Coronary artery disease, stroke, and prolonged surgery were significantly associated with an increased risk of respiratory failure.

• Risk Factors for 90-Day Mortality:

 • Internal fixation, coronary artery disease, and older age were associated with higher 90-day mortality.

• Risk Factors for VTE:

• Distal femur fractures were significant risk factors for VTE.

• VTE prophylaxis methods were not associated with an increased or decreased risk of VTE.

"Our study findings indicate that pulmonary complications are linked to poorer outcomes, with several pre-existing health conditions serving as key risk factors. As the number of older patients undergoing femur fracture surgery continues to rise, it will be crucial to thoroughly assess these risk factors to better prevent complications and improve patient outcomes," the researchers concluded.

Reference:

Chai J, Kang J, Seo WJ, Kang HK, Koo HK, Oh HK, Choo SK, Kang J. Incidence and Risk Factors of Pulmonary Complications Following Femur Fracture Surgery in Patients Aged 80 Years and Older. Clin Interv Aging. 2024;19:1843-1854. https://doi.org/10.2147/CIA.S481641