Does Preoperative Pneumonia Affect Complications of Geriatric Hip Fracture Surgery?

Preoperative pneumonia, reported in 0.3% to 3.2% of hip fracture patients, may be a risk factor for adverse outcomes of hip fracture repair. No studies have reported on baseline differences or adverse outcomes in surgically managed geriatric hip fracture patients with and without preoperative pneumonia, and no data argue for or against delaying surgery in these patients. A retrospective cohort of geriatric patients with operatively treated hip fractures from 2005 to 2012 was identified in the National Surgical Quality Improvement Program database. Preoperative pneumonia was present in 82 (1.2%) of 7128 geriatric hip fracture patients identified and was associated with male sex, transfer status, functional status, preoperative anemia, confusion, dyspnea at rest, and chronic obstructive pulmonary disease. Multivariate analysis of 30-day outcomes of hip fracture repair revealed that preoperative pneumonia was associated with a higher risk for any adverse event (relative risk [RR] = 1.44), serious adverse event (RR = 1.79), and death (RR = 2.08) after hip fracture repair. Underweight body mass index at time of surgery (<18.5 kg/m²) was predictive of 30-day mortality (RR = 4.67). Surgical delay of 1 to 4 days was not associated with adverse events. Geriatric hip fracture patients with preoperative pneumonia, especially the underweight, are at increased risk for complications and death after hip fracture repair. We cannot recommend against early hip fracture surgery in this population.