https://orcid.org/0000-0003-0678-4056
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Abstract
Purpose
Pneumonia is one of the common complications of hip fracture. This study aimed to evaluate the risk factors and apply a nomogram to predict postoperative pneumonia in elderly hip fracture patients.
Materials and Methods
From August 2014 to October 2019, 1113 hip fracture patients who were older than 65 years and underwent surgical treatment in our hospital were subjects of this study. Univariate and multivariate Cox analyses were used to identify independent risk factors. A predictive nomogram model was built, and the discrimination and calibration were determined by receiver operating characteristic and calibration plot.
Results
A total of 166 patients developed pneumonia after operation (14.91%, pneumonia group) while the remaining 947 patients did not (85.09%, non-pneumonia group). According to the results, body mass index (OR, 0.76, 95% CI, 0.70 to 0.84, P<0.001), serum albumin (OR, 0.86, 95% CI, 0.79 to 0.93, P<0.001), c-reactive protein (OR, 1.01, 95% CI, 1.00 to 1.92, P=0.011), functional status (OR, 2.94, 95% CI, 1.69 to 5.10, P<0.001) and time to surgery (OR, 4.56, 95% CI, 2.64 to 7.88, P<0.001) were identified as independent risk factors of pneumonia. The area under the curve value for postoperative pneumonia risk was 0.905, and the P-value of the Hosmer-Lemeshow calibration test was 0.529.
Conclusion
Our nomogram model can be used to predict the risk of pneumonia in elderly hip fractures after surgery and provide clinicians with guidance for better perioperative intervention to improve prognosis and reduce mortality.
Acknowledgments
This research was supported by Wenzhou Basic Scientific Research project funding (No. Y20180321), Zhejiang Natural Science Fund project funding (No. LY19H060003). Guangheng Xiang and Xiaoyu Dong are co-first authors for this study.
Data Sharing Statement
Patient data comes from our hospital’s medical record follow-up database, transparent and available.
Ethical Statement
The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study followed the guidelines of the “Declaration of Helsinki” and was approved by the hospital’s ethics committee (Research Ethics Committee of the Second Affiliated Hospital of Wenzhou Medical University, L-2020-22). The data were analyzed anonymously and personal identifiers were completely removed; therefore, the requirement for informed consent was waived.
Code Availability
Statistical analyses were carried out using R version 3.6.1 for Windows (R Foundation for Statistical Computing, Vienna, Austria) and EmpowerStats (http://www.empowerstats.com, X&Y Solutions, Inc., Boston, MA).
Author Contributions
Guangheng Xiang and Yi-Min Weng contributed to the conception and design. Yi-Min Weng, Yongzeng Feng and Jian Xiao contributed to the administrative support. Guangheng Xiang, Tao Xu, Zili He, Chen-Rong Ke and Xiaoyu Dong contributed to the provision of study materials or patients. Guang-Heng Xiang, Yongzeng Feng and Jian Xiao contributed to the collection and assembly of data. Guangheng Xiang, Chen-Rong Ke and Xiaoyu Dong contributed to the data analysis and interpretation. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
Guangheng Xiang, Xiaoyu Dong, Tao Xu, Yongzeng Feng, Zili He, Chenrong Ke, Jian Xiao and Yi-Min Weng have no conflicts of interest to disclose in relation to this article. The authors declare no competing financial interests.