Clinical Characteristics And Risk Factors Of Pulmonary Infection In Elderly Patients After Orthopedic Surgery

ObjectiveTo investigate the clinical characteristics and risk factors of pulmonary infection in elderly patients after orthopedic surgery,and propose corresponding countermeasures,so as to provide scientific reference for the prevention and control of pulmonary infection in elderly patients after orthopedic surgery.MethodsThe 2251 elderly patients undergoing orthopedic surgery from January1,2014 to December 31,2017 in Yongchuan Hospital affiliated to Chongqing Medical University were selected as the research objects.The incidence of nosocomial infection was retrospectively investigated by using the real-time monitoring system of nosocomial infection in Xinglin Hospital of Hangzhou.The clinical characteristics of pulmonary infection in elderly patients after orthopedic surgery were analyzed.Then,by adopting the 1?1 matched case-control study method,according to the inclusion and exclusion criteria and matching conditions,the elderly patients with pulmonary infection after orthopedic surgery were set as the case group,and the elderly patients without pulmonary infection afterorthopedic surgery in the same period were selected as the control group.The clinical data of the two groups were retrospectively investigated,and thirteen factors including underlying diseases,hypoproteinemia and emergency surgery etc.were selected for univariate analysis.Statistically significant related factors were screened out and multivariate conditional logistic regression analysis was further carried out to identify the risk factors of pulmonary infection,and intervention measures were proposed.Results1.There were 61 cases of pulmonary infection after orthopedic surgery in 2251 elderly patients,and the incidence of pulmonary infection after orthopedic surgery in elderly patients was 2.71%.The incidence of pulmonary infection after orthopedic surgery in males and females was3.68% and 2.04%,respectively,and there was a significant difference between the two groups(P=0.024<0.05).The incidence of pulmonary infection after orthopedic surgery was 2.00%,2.62% and 4.68% in 60~69years old group,70 ~ 79 years old group and over 80 years old group,respectively,and the difference was statistically significant(P=0.015<0.05).The incidence of pulmonary infection after orthopedic surgery in the three sub-professional groups from low to high was joint group,spine group and trauma group.The incidence of pulmonary infection after orthopedic surgery was 2.38%,2.92% and 3.03% respectively.There was no significant difference(P=0.687>0.05).In sixty-one patients with pulmonary infection after orthopedic surgery,a total of 113 strains of pathogens were detected,including 20 strains of multi-drug resistant bacteria(17.70%).The top three pathogens were klebsiella pneumoniae(27.43%),acinetobacter baumannii(14.16%)and candida albicans(11.50%),respectively.The mortality rate of patients with pulmonaryinfection after orthopedic surgery(4.92%)was significantly higher than that of patients without pulmonary infection(0.23%),and the difference was statistically significant(P=0.001<0.05).2.Univariate analysis showed that pulmonary infection in elderly patients after orthopedic surgery was related to underlying diseases,smoking history,hypoproteinemia,emergency surgery,preventive use of antibiotics,admission to ICU,perioperative use of ventilators,general anesthesia,duration of surgery,NNIS classification,postoperative bedridden time,but not to the type of incision and the implant.Further multivariate conditional logistic regression analysis showed that hypoproteinemia(OR=7.854,P=0.039<0.05),NNIS grade?2(OR=6.893,P=0.010<0.05),postoperative bedridden time?14d(OR=12.123,P=0.004<0.05)were the independent risk factors for pulmonary infection in elderly patients after orthopedic surgery.Conclusion1.The incidence of pulmonary infection in elderly patients after orthopedic surgery is relatively higher,and the incidence is positively correlated with age.The incidence of pulmonary infection in elderly patients after orthopedic surgery is higher than that in females.The pathogens are mainly gram-negative bacteria,and fungi and multi-drug resistant bacteria increased.Postoperative pulmonary infection affects the prognosis of elderly patients after orthopedic surgery.2.Hypoproteinemia,NNIS grade?2,and postoperative bedridden time?14d are independent risk factors of pulmonary infection in elderly patients after orthopedic surgery.3.Pulmonary infection in elderly patients after orthopedic surgery is caused by a combination of factors.In clinical practice,elderly patients oforthopedic with high-risk factors should be closely monitored,perioperative risk assessment and multidisciplinary cooperation should be strengthened,and active intervention measures should be taken to effectively prevent and control the occurrence of pulmonary infection.