Risk Factors of Postoperative Atelectasis and the Preventive Effect of a Risk-Stratified Nursing Model in Elderly Patients With Severe Polytrauma.

AIM: To investigate the incidence and independent risk factors for postoperative atelectasis in elderly patients with severe polytrauma, and to evaluate the preventive effect of a risk-stratified nursing model developed based on these factors.

METHODS

This retrospective study comprised two components. The first component included 108 elderly patients with severe polytrauma who underwent surgery between March 2021 and March 2024. Based on postoperative atelectasis, patients were categorized into an atelectasis group (n = 31) and a non-atelectasis group (n = 77). Baseline characteristics, injury- and surgery-related variables, and preoperative laboratory parameters were collected from both groups. Univariable analysis and multivariate logistic regression were performed to identify independent risk factors and to estimate their odds ratios (ORs) with 95% confidence intervals (CIs). The combined predictive performance of these factors was evaluated using receiver operating characteristic (ROC) curve analysis. The second component was an intervention analysis to evaluate the effectiveness of a stratified nursing protocol established based on the derived risk scoring system. Using a before-after design, the incidence of postoperative atelectasis was retrospectively analyzed in a subsequent cohort of 48 elderly patients with severe polytrauma who received this nursing intervention between June 2024 and June 2025.

RESULTS

The incidence of postoperative atelectasis in elderly patients with severe polytrauma was 28.70% (31/108). Multivariate logistic regression analysis identified advanced age (>75 years), elevated body mass index (BMI) (>24 kg/m2), concomitant pulmonary injury, substantial blood loss volume (≥3000 mL), prolonged time from injury to surgery (≥6 h), and extended operative time (≥2 h) as independent risk factors (all p < 0.05). The combined predictive model incorporating these factors yielded an area under the curve (AUC) of 0.924 (95% CI: 0.876-0.971), with a sensitivity of 83.9% and specificity of 87.0%. A risk-scoring system derived from regression coefficients stratified patients into low- (0-2 points), moderate- (3-4 points), and high-risk (≥5 points) groups. Implementation of the corresponding risk-stratified nursing model was associated with a reduction in postoperative atelectasis incidence to 10.42% (5/48) in the subsequent intervention cohort.

CONCLUSIONS

Postoperative atelectasis is common among elderly patients with severe polytrauma and is influenced by multiple clinical factors. A risk-stratified nursing model based on identified independent predictors demonstrates potential to reduce the incidence of atelectasis in clinical practice and warrants further validation.