Why Does Hip Fracture Cause Pneumonia?

Why do people get pneumonia after hip fracture?

Discussion – The present study investigated the prevalence and risk factors for POP following geriatric hip fracture surgery through a meta-analysis. The prevalence of POP was 5% among 24 studies; 6 studies reported a prevalence of more than 10%.7, 10 – 14 In particular, one study a very high prevalence of 18%.11 That study was conducted on patients who underwent subtrochanteric fracture surgery, a relatively high proportion of whom had lung malignancies (6.3%). Our meta-analysis of five important risk factors revealed that age, male sex, chronic respiratory diseases, delayed surgery and low serum albumin were all significantly associated with the occurrence of POP. Age and sex are known risk factors for morbidity and mortality after hip fracture.15 The meta-analysis included 8 studies that analyzed age as a risk factor. Although the age cutoff for high risk of POP following geriatric hip fracture surgery was variable, three studies reported that patients aged >80 years were at a particularly high risk for POP.14, 16, 17 Furthermore, the risk for POP increases with age, and older patients who developed POP had longer hospital stays and higher mortality rates.18 This suggests that the elderly, especially those over the age of 80 years, are more likely to develop POP after hip fracture surgery and thus require special attention. In 6 studies, males were found to be at a greater risk for POP after hip fracture despite a higher incidence of hip fractures in females. This may be explained by the fact that males tend to have poorer health and more comorbidities compared to females.17 We found that delayed surgery was a risk factor for POP, based on moderate-quality of evidence. Many studies and guidelines recommend that older hip fracture patients undergo surgery as soon as possible to reduce the risk of postoperative complications especially pneumonia.19 Early surgery leads to early restoration of motor function and fewer of the complications associated with bed rest.13 Six papers on surgical delay were included in our meta-analysis. One study found that a delay of more than 24 h was associated with an increased risk of POP, while two others found that a delay of more than 36 h increased the risk (although in one of these studies the association lacked statistical significance). The remaining three studies demonstrated an increased risk of POP with a delay of more than 48 h. Therefore, it is important to perform the surgery as soon as possible, preferably within 48 h, to prevent POP. Chronic respiratory diseases were also found to be associated with the risk of POP after hip fracture surgery in five studies. Four of those studies reported an increased risk with chronic obstructive pulmonary disease (COPD).2, 11, 16, 17 In one study, COPD patients had higher rates of postoperative complications, including 30-day pneumonia, 30-day readmission, 30-day acute respiratory failure, and 1-year mortality, as well as longer hospital stays.2 Prevention and early management of fractures is important in COPD patients. Most COPD patients are elderly, smokers, and oral- or inhaled-steroid users, so the risk of osteoporosis and fractures is high.20 Pharmacologic therapies such as inhalers are effective for improving lung function and preventing acute COPD exacerbations. Although the effectiveness of inhalers for preventing complications, such as pneumonia, after hip fracture surgery has not been well studied, use of an inhaler and chest care after surgery may help prevent complications after surgery in COPD patients. Our results demonstrated that a low serum albumin level was a risk factor for POP after hip fracture surgery. Serum levels of albumin, a negative acute phase protein produced in the liver at a rate of 12-25 g/d, reflect nutritional status.21 Serum albumin concentrations are influenced by multiple factors, including nutritional status, liver failure, malignancy, surgical trauma, inflammation, comorbidities, and other conditions.22 Low serum albumin levels may compromise the immune system.23 Patients with hypoalbuminemia have lower nutritional reserves and weaker immune systems.12 Previous studies have reported that preoperative hypoalbuminemia is a risk factor for postoperative complications in various types of surgery.24 Malnutrition is particularly prevalent among the elderly, and is an independent risk factor for POP after hip fracture surgery.12 Measuring the serum albumin level is a simple method to assess protein energy malnutrition, which is a modifiable factor.25 Nutritional supplementation for hypoalbuminemia may reduce the incidence of POP in elderly hip fracture patients. Our study was the first to analyze the risk factors for POP in elderly hip fracture patients, through a meta-analysis of recent studies. However, this study had several limitations. First, although designed as a meta-analysis of elderly patients, it also included studies conducted on adult patients in other age groups. However, in line with hip fractures occurring mainly in the elderly, the mean age of the patients in these studies was over 65 years. Second, it was not possible to determine the cause of POP because most of the studies did not distinguish between aspiration pneumonia and other types. Third, we used the original data from the studies, and confounding factors and bias caused by basic comorbidities were not fully addressed. Finally, methodological issues existed for all included studies that might influence conclusions, and this is especially the case for included retrospective nonrandomized studies. Furthermore, limitations include the small number of eligible studies and the significant heterogeneity between the included studies regarding outcomes reported. Although the random effect model was used to address heterogeneity among the studies evaluated, the conclusions should be carefully interpreted.

Can you get pneumonia from a hip fracture?

Background – Hip fractures are a major health problem and the number of hip fractures is expected to increase by approximately 2% annually over the next 30 years, Hip fractures are associated with increased risk of morbidity and mortality, Furthermore, the coronavirus disease pandemic, has forced an unprecedented period of challenge for the management of patients with hip fractures,

• Postoperative pneumonia (POP) is a devastating complication that can occur after hip fracture surgery,
• However, few studies have been performed to elucidate this complication and investigate patients with hip fracture and POP.
• The incidence of hip fracture-related pneumonia has been reported to range from 4 to 15%,

Evidence has shown that POP is associated with various predisposing factors, including older age, male sex, multiple medical comorbidities, and hypoalbuminemia, With the progress in medical technologies and aftercare of patients, clinicians are increasingly focusing on the prevention and treatment of POP.

To medically optimize patients and provide better perioperative care, identifying various potential risk factors is important for POP. To the best of our knowledge, no formal systematic review and meta-analysis has investigated and summarized the risk factors for POP following hip fracture surgery. Therefore, this meta-analysis aimed to summarize the risk factors for the development of POP in patients undergoing hip fracture surgery.

The results of this study are potentially beneficial for clinicians to identify high-risk patients and help prevent postoperative POP following hip fracture surgery.

Why does hip fracture cause pulmonary embolism?

Complications of Hip Fracture – Serious complications can result from a hip fracture. A patient may have to remain in traction for a specified period of time after surgery. Blood clots can occur in the veins, usually in the legs. If a clot breaks off, it can travel to a blood vessel in the lung. This blockage, called a pulmonary embolism, can be fatal.

What is the most significant complication after hip fracture?

Key points about hip fracture –

Most hip fractures happen to people of older age. A fall is the most common reason for a hip fracture among elderly adults. Hip fracture is more common among women. Osteoporosis and advancing age are the major risk factors. A fracture of the hip is generally treated with surgery. Serious complications can result from a hip fracture. Women at menopause should consider having a bone density test. Regular weight-bearing exercise helps to prevent a hip fracture.

Why is mortality so high after hip fracture?

Background – Hip fracture is the most serious consequence of falling in older people with osteoporosis; 87% to 96% of hip fracture patients are 65 years of age or older, Hip fractures are associated with increased mortality rates; the magnitude of the increased mortality and the length of its duration, however, are unclear.

• One study stated that survival declines soon after hip fracture, but thereafter parallels the expected survival of the general population,
• A recent systematic epidemiologic review, however, showed that patients are at increased risk for premature death for many years after hip fracture,
• Excess mortality after hip fracture may be linked to complications following the fracture, such as pulmonary embolism, infections, and heart failure,

Factors associated with the risk of falling and sustaining osteoporotic fractures may also be responsible for the excess mortality, Excess mortality after fracture may be due to the individual characteristics of the person sustaining the hip fracture ; e.g., low-bone density is associated with increased non-trauma mortality, even without fractures.

• Despite numerous mortality studies, further analysis of mortality and cause of death is important to identify the risk factors for death following trauma and to anticipate complications,
• Although several studies report excess mortality in hip fracture patients compared to controls the issue remains under-recognized in many countries.

Furthermore, sex- and cause-specific mortality after hip fracture has not been extensively investigated, The aims of the present population-based study were to evaluate patterns of death by sex and hip fracture type and to evaluate mortality after hip fracture compared to the general population with a specific focus on the cause of death.

How do you prevent pneumonia after hip fracture?

Early mobilization and postoperative pulmonary exercises are recommended non-pharmacological interventions for the prevention of postoperative pneumonia. Stahl et al. and Chang et al. have shown a decrease in postoperative pneumonia incidence after intensified physical therapy in patients with hip fracture.

Can an 80 year old recover from a broken hip?

Dear Doctors: Our grandmother, who is 91, fell and broke her left hip. She wound up needing a partial hip replacement. I’ve read that hip fractures are dangerous for older adults. Can you explain why? Is she still at risk, even though the surgery went well? Dear Reader: A hip fracture is a serious and yet common outcome when an older adult has a fall.

1. It occurs due to the progressive decrease in bone mass that often affects women and men as they age.
2. Another risk for hip fracture is osteoporosis, a skeletal disease marked by a loss of bone density, which leaves bones porous, thin and brittle.
3. Because of the hormonal changes that occur during menopause, women are at increased risk of developing osteoporosis.

(Although it’s more common in women, men can develop osteoporosis, as well.) These skeletal changes are reflected in hospital records, which show that more than 300,000 adults over the age of 65 are admitted each year due to a hip fracture, nearly all the result of falling, usually sideways.

1. Unfortunately, it’s true that a hip fracture in older adults can contribute to poor outcomes, including an increased risk of death.
2. A number of factors play a role.
3. These include the age of the patient, their sex, and the health problems the person was living with before the fracture, such as cardiovascular, pulmonary or neurological issues; diabetes; declining cognition or frailty.

Most hip fractures in older adults require surgery to restore mobility and to manage pain. This puts patients at risk for a range of post-surgical complications, including infection, blood clots in the lungs or legs, bedsores, urinary tract infection and pneumonia.

Recovery for adults who are older or frail can take months. This often leads to further loss of muscle mass, which then increases the risk of a subsequent fall. Due to the length of recovery, a hip fracture also often leads to a decrease in independence. Following surgery, many patients are surprised to learn that physical therapy starts almost immediately.

It’s an important part of the recovery process. Not only does physical therapy help patients regain mobility, but it also helps prevent the more serious complications associated with being immobilized, such as infection, developing a blood clot or pneumonia.

Proper nutrition, with adequate protein, also plays a role in recovery. So does occupational therapy. It keeps the patient mentally and emotionally engaged, and can lessen the risk of depression. One factor that can go overlooked, particularly among older adults, is pain management. It’s crucial to an optimal recovery.

Make sure your grandmother’s pain levels are being clearly communicated, and that her health care providers are responding appropriately. It’s useful for her to think of pain in terms of a scale of 1-to-10, and important for her to communicate to her doctors and nurses what she is experiencing.

How long does it take a 70 year old to recover from hip surgery?

Hip replacement recovery: timeline, tips and information On the day of your hip replacement surgery You will need to admit yourself into hospital several hours before your surgery. The surgery will take two to three hours and you will then be taken to a recovery room to closely monitor your vital signs (eg heart rate and blood pressure) and assist you if you develop any side effects from the anaesthesia, such as vomiting.

• You will not be fully alert for a further two hours after surgery while the general anaesthesia wears off.
• Once the general anaesthesia wears off, you will be taken to your hospital room.
• You will be given liquid meals for the rest of the day as well as several medications administered via a drip that is inserted into a vein in your arm.

These medications will include pain relief, blood thinners and antibiotics to prevent infection. You may also be given compression stockings to wear on your legs — this helps reduce the chances of developing while you are less mobile. Your care team will encourage you to sit up, get out of bed and try walking as soon as possible.

1. You will be helped by a physiotherapist.
2. The sooner you start moving, the better your recovery.
3. During your stay in hospital, which will likely last one to three days, your care team will encourage you to move around more.1–2 days after surgery You should now be able to get out of bed with some help and be able to move around with the use of a walking aid eg crutches or a walker.

Try to stay moving for 20 to 30 minutes at a time but stick to a slow pace. This will gradually help strengthen your muscles and improve your blood circulation to reduce the chances of blood clots developing. Your physiotherapist will also show you specific exercises to practice daily that will improve the strength and range of motion of your hip.3–4 days after surgery By day three, you may be able to walk to the bathroom by yourself and any pain will be manageable.

Bathing and showering Bending down to put on your socks and shoes Carrying items (eg food and drink) while using a cane or walker Getting in and out of bed Getting on and off the toilet Getting in and out of a car

You will need to arrange for someone to drive you home and stay with you for several days or weeks as you, You will also be given a programme of exercises to perform daily by your physiotherapist. Your physiotherapist will advise you on how much weight the leg operated on can bear.

They may also give you guidance on how to sleep, sit and/or bend comfortably and safely for the next few months or for the foreseeable future.4–10 days after surgery During this time there is a significant risk of infection if you don’t follow your care team’s instructions on how to take care of your wound.

Stay alert for any signs of infection and inform your doctor if you notice any. Signs of infection include, redness or discharge from your wound. As you won’t be able to shower or bathe until the staples holding your wound together are removed, you will need to have sponge baths to keep your body and your wound clean.

1. Make sure your wound stays clean and dry for three weeks after surgery and following the instructions of your care team, change the dressing when needed.10–14 days after surgery A nurse will remove the staples from your wound and you can return to having baths or showers.
2. You can also start walking without a walking aid.3–6 weeks after hip replacement surgery You may not need a walking aid anymore and can return to light activities.

If you are no longer taking any pain medication, your doctor may clear you to drive again. If you find it difficult to get into your car, try easing yourself in backwards and then swinging your legs into the car. After around six weeks, following the advice of your doctor, you may be able to have sex again.

1. However, you should avoid strenuous sex or positions that will strain your hip.
2. If you still need a walking aid, or have strength or balance problems, you may not have recovered enough to have sex.
3. After around six to 12 weeks, you may also be able to return to work depending on how physically demanding your work is.

You should continue walking often every day and avoid sitting for long periods of time. This will help reduce your and stiffness. Your physiotherapist will advise you on which exercises you can now practice daily to strengthen and stretch your muscles.10 weeks to one year after surgery After around 10 to 12 weeks, you should be able to return to most of your normal activities.

1. However, a complete recovery will take six to 12 months.
2. In most cases, any pain will have gone away after a year, although some people continue to experience some mild pain or discomfort after a year.
3. You will need to keep up with your daily physiotherapy exercises and regular walking.
4. This will continue to strengthen your muscles and improve your range of motion, flexibility and balance.

Your physiotherapist will advise you on which exercises to perform; these will likely focus on body mechanics, posture and weight-bearing. : Hip replacement recovery: timeline, tips and information

What happens to body after hip fracture?

What are the symptoms of a hip fracture? – Symptoms of a hip fracture typically come on suddenly. But they can appear gradually and worsen with time. Signs of a hip fracture include:

Pain: Usually, hip pain is severe and sharp. But it can also be mild or achy. Most people feel pain in the thigh, outer hip, pelvis and groin area. Pain may radiate down your buttock to your leg ( sciatica ). You may also feel pain in your knee. Limited mobility: Most people with a hip fracture can’t stand or walk. Sometimes, it may be possible to walk, but it’s extremely painful to put weight on the leg. Physical changes: You may have a bruise on your hip. One of your legs may appear shorter than the other. The hip might look like it’s out of position, twisted or rotated.

How does pulmonary embolism occur in fractures?

CLINICAL FEATURES – The principal clinical features of FES are respiratory failure, cerebral dysfunction, and skin petechiae. The clinical manifestations may develop 24–72 h after trauma (and especially after fractures) when fat droplets act as emboli, becoming impacted in the pulmonary microvasculature and other microvascular beds such as in the brain.

Embolism begins rather slowly and attains a maximum in about 48 h. The initial symptoms are probably caused by mechanical occlusion of multiple blood vessels with fat globules that are too large to pass through the capillaries. Unlike other embolic events, the vascular occlusion in fat embolism is often temporary or incomplete since the fat globules do not completely obstruct capillary blood flow because of their fluidity and deformability.

The late presentation is thought to be a result of hydrolysis of the fat into the more irritating free fatty acids, which then migrate to other organs via the systemic circulation. It has also been suggested that paradoxical embolism occurs due to shunting.

Pulmonary dysfunction is the earliest to manifest and is seen in 75% of patients; it progress to respiratory failure in 10% of the cases. The manifestations include tachypnea, dyspnea, and cyanosis; hypoxemia may be detected hours before the onset of respiratory complaints. Cerebral changes are seen in 86% of patients with FES.

These changes are nonspecific, ranging from acute confusion to drowsiness, rigidity, convulsions, or coma. Cerebral edema contributes to the neurological deterioration. The skin dysfunction is manifested as a nonpalpable petechial rash in the chest, axilla, conjunctiva, and neck that appears within 24–36 h and disappears within a week in 20–50% of patients.

The particular distribution of the rash is related to the fact that the fat particles float in the aortic arch like oil in water and thus get embolized to the nondependent areas of the body. Several other signs are nonspecific, like tachycardia and pyrexia. Renal changes may include lipuria, oliguria, or anuria and hepatic damage may manifest as jaundice.

The retina may show exudates, edema, hemorrhage, or intravascular fat globules. There may be history of orthopedic or plastic surgical procedure or parenteral lipid transfusion.

Why does trauma cause pulmonary embolism?

Discussion – Post-traumatic PE is an acute respiratory disorder caused by the occlusion of the pulmonary arterial bed, leading to a life threatening condition, due to a potentially reversible right ventricular failure, Diagnosing PE may be difficult in injured patients.

1. Clinical presentation is variable, symptoms are often masked by multiple painful injuries, and altered mental status.
2. Patient classically present dyspnea, tachypnea, chest pain and hemoptysis.
3. Severe cases may also involve circulatory instability, or shock.
4. Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of PE, showing obstruction in the pulmonary artery or its branches.

It is a well-described clinical entity occurring in up to 24%, Reviewing studies, we found no uniform definition of “early” or “late” post-traumatic PE. Nevertheless, PE occur commonly between the fifth and the seventh day post injury and is rare before the fourth day,

• It is classically caused by the development of DVT in the lower extremities or pelvis that embolize to the pulmonary circulation,
• However, Velmahos et al.
• Reported that the majority of patients with early PE did not have evidence of DVT and suggested that early PE may have a different pathophysiology.

Localized inflammation, occult vascular injury and the low flow state that occur after thoracic injury are a possible etiology for ‘in situ’ formation of a clot in the pulmonary arteries, This theory may explain why thoracic injury is associated with PE but not significantly with DVT.

The factors associated with early post-traumatic PE have been understudied. Reviewing the literature, risk factors included elder age, obesity, long bone fractures, and severe injury,,,, None of these were present in our patient. Therefore, multidisciplinary discussion questioned the diagnosis of early post-traumatic PE because of the less severe nature of the trauma and the timing so soon of occurrence.

The possibility of pre-injury PE was considered, however, the patient had no thromboembolic risk factors and no prior history of COVID-19 infection. As hypercoagulability is present acutely after trauma due to direct tissue injury, this theory may explain the early development of PE in our patient.

How do you prevent blood clots after a hip fracture?

Anti-Clotting Medicine – An anti-clotting medication may be prescribed to prevent blood clots and to treat them. This class of drug is referred to as an anticoagulant, or blood thinner. Joint replacement patients typically begin to receive anti-clotting medicine the day after surgery, continuing throughout their hospital stay and into at-home rehabilitation.

Heparin: Standard heparin and low molecular weight heparin are given by an injection under the skin. You may be able to give yourself the injections, or have a visiting nurse administer them. Warfarin: Your doctor may prescribe warfarin instead of heparin or low molecular weight heparin for blood clot prevention. Warfarin is taken orally in pill form once daily. Direct oral anticoagulants: These drugs are the newest type of anti-clotting medicines and are available in a pill form, which are also taken orally once or twice daily depending upon which medication you’re prescribed.

You and your doctor should review your treatment options together, along with their pros and cons and possible side effects. Some of the drugs require adherence to a schedule, careful management of your diet, and regular blood testing. Click for more specifics about the use of each type of medicine.

What is the most serious hip injury?

Traumatic Subluxation and Dislocation – Of all the injuries mentioned in this article, traumatic subluxation and dislocation is the most serious injury that can lead to long-term side-effects. Hip traumatic subluxation and dislocation happen when an injury forces the femur to dislocate or shift away from the pelvic bone.

What are red flags for a fractured hip?

Check if you have a broken hip – A broken hip usually happens because of a fall or injury. It’s more common in older people and people who have osteoporosis, Symptoms of a broken hip include:

pain in the hip or upper legswelling and bruising around your hip and upper legnot being able to stand or put weight on the affected hip and legdifficulty moving your hip and legthe affected leg is at an odd angle or is shorter than the unaffected leg

How long can a 90 year old live after a hip fracture?

Results – A total of 240 participants of whom 178 (74.2%) were female and 62 (25.8%) were male were included in the study. The mean baseline age of participants was 88.6 (SD, 5.6) years, ranging from 70 to 101 years. The mean baseline mini-mental state examination (MMSE) score was 8.0 (SD, 7.8); 7.8% of participants had normal cognition or mild cognitive impairment, 33.8% suffered moderate cognitive impairment and 58.7% suffered severe cognitive impairment.34.6% participants had delirium at baseline.

The mini-nutritional assessment score was 5.3 (SD, 2.3). The mean BMI was 25.2 (SD, 4.9) kg/m 2 with 5.4% underweight, 46.6% normal, 31.2% overweight and 16.7% obese. Ninety-four participants had experienced a previous fracture of any type and 32 had experienced a previous hip fracture. The most common surgery was intramedullary nailing (36.3%) and three participants had total hip replacement.

Table 1 shows the baseline characteristics of participants. Table 1 Baseline characteristics of the study population. The mean follow-up time for participants was 1.2 years, median was 1.1 years with range from 0.06 to 3.6 years. In total, 149 deaths occurred during the follow-up period.

1. Aplan–Meier curves (Fig.1 ) showed that being female (log rank test: p = 0.0071), being of younger age (log rank: 0.0214) and having a higher MMSE score (log rank test: p = 0.0045) were associated with better survival.
2. The survival curves were steeper (i.e.
3. Faster decline) early in the follow up period indicating that mortality rate was highest close to the time of hip fracture.

The cumulative death rate within three months was 25.0% (60/240) and the cumulative death rate during the whole study period was 62.1% (149/240). Mortality rate was 118 deaths per 100 person-years within 3 months while the mortality rate of the whole study period (3.6 years) was 51.3 deaths per 100 person-years. Kaplan–Meier survival plot after hip fracture. Table 2 showed being female indicated longer life expectancy (coefficient (β) = 0.86, 95% confidence interval (CI):0.39 to 1.34, p = 0.0004). Older age was associated with shorter life expectancy (β = − 0.06, 95% CI: − 0.10 to − 0.02, p = 0.0043).

• Relative to severe cognitive impairment, normal or mild-cognitive impairment (β = 1.18, 95% CI: 0.05 to 2.31, p = 0.0414) and moderate cognitive impairment (β = 0.56, 95% CI: 0.07 to 1.04, p = 0.0237) were associated with longer life expectancy.
• Randomisation groups, nutritional status, BMI, previous fractures of any type, previous hip fracture, and different surgery types were not associated with life expectancy.

Table 2 Weibull AFT model assessment of the effect of covariates on survival time. Using the Weibull AFT model, we calculated life expectancy for different ages by sex. For females who underwent surgical treatment for hip fracture, estimated life expectancy would be 8.2 years for those aged 70 years, 4.8 years for those aged 80 years, and 2.8 years for those aged 90 years. Life expectancy after hip fracture by age and gender. Results of sensitivity analysis testing the same covariates in the Weibull AFT model in a multivariable Cox regression model did not yield different results. All estimates were consistent with the Weibull AFT model (in terms of association, direction and significance) (Table 3 ). Table 3 Sensitivity analysis, Cox proportion model results.

What is life expectancy after hip fracture?

Causes of Death After Hip Fracture – Several factors can increase the risk of death after a hip fracture. According to a 2015 study in the Bone and Joint Journal, the three most common causes of early death in people following a hip fracture were:

• Respiratory infections (35%), most commonly pneumonia
• Complications of coronary artery disease (21%), including a heart attack or stroke
• Complications of heart failure (13%), including acute kidney failure and multi-organ failure

Other causes include post-surgical complications such as pulmonary embolism (a blood clot in the lung), gastrointestinal bleeding, and sepsis (an immune overreaction to infection). Most of these early deaths occur within one to three months of the break.

Even if an older person survives beyond the critical one-year threshold, a hip fracture can continue to amplify the risk of death thereafter. When a person’s functional mobility is severely reduced, they are less able to manage chronic conditions like heart disease, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease (COPD) —all of which are influenced by exercise and lean muscle mass.

As result, they are more likely to succumb earlier to these diseases than peers who retain their functional mobility. While age is a major risk factor for falls, a person who is healthy and fit may be considered to have a lower chronological age, leaving them less susceptible to falls and hip fractures.

1. Liu E, Killington M, Cameron ID, et al. Life expectancy of older people living in aged care facilities after a hip fracture, Sci Rep.2021;11:20266. doi:10.1038/s41598-021-99685-z
2. Burns E, Kakara R. Deaths from falls among persons aged ≥65 years — United States, 2007–2016, MMWR Morbidity and Mortality Weekly Report,2018;67(18):509-514. doi:10.15585/mmwr.mm6718a1
3. Adeyemi A, Delhougne G. Incidence and economic burden of intertrochanteric fracture: a Medicare claims database analysis, JB JS Open Access.2019 Mar 27;4(1):e0045. doi:10.2106/JBJS.OA.18.00045
4. Adeyemi A, Delhougne G. Incidence and economic burden of intertrochanteric fracture: a Medicare claims database analysis, JB JS Open Access.2019 Mar 27;4(1):e0045. doi:10.2106/JBJS.OA.18.00045
5. Mundi S, Pindiprolu B, Simunovic N, Bhandari M. Similar mortality rates in hip fracture patients over the past 31 years: a systematic review of RCTs, Acta Orthopaedica,2014;85(1):54-9. doi:10.3109/17453674.2013.878831
6. Katsoulis M, Benetou V, Karapetyan T. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project, J Internal Med,2017;281(3):300-10. doi:10.1111/joim.12586
7. Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture – a systematic review, World J Orthop.2019 Mar 18;10(3):166–175. doi:10.5312/wjo.v10.i3.166
8. Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ. Cause of death and factors associated with early in-hospital mortality after hip fracture, Bone Joint J.2015;9(2):35248. doi:10.1302/0301-620X.97B2.35248
9. De Joode SGCJ, Kalmet PHS, Fiddelers AAA, Poeze M, Blokhuis TJ. Long-term functional outcome after a low-energy hip fracture in elderly patients, J Orthop Traumatol.2019 Dec;20:20. doi:10.1186/s10195-019-0529-z

Additional Reading

Falls and Fractures. US NIH National Institute on Aging Public Information Sheet.

By Sharon Basaraba Sharon Basaraba is an award-winning reporter and senior scientific communications advisor for Alberta Health Services in Alberta, Canada. Thanks for your feedback!

Which fracture has highest mortality?

4. Discussion – To our knowledge, this is the first study assessing mortality rates and standardized mortality ratios for different age groups of different fracture locations in the same well-defined adult population. The findings in the present study demonstrate that SMRs as well as absolute mortality rates vary substantially in relation to age and for different fracture locations. Fracture locations associated with the highest SMR within each age group are, however, consistent across age groups. The overall SMR after sustaining any type of fracture was not markedly different for the different age groups, neither at 30 days nor at 1 year post-fracture. However, when comparing SMRs for different fracture locations, both similarities and differences were observed between the age groups. The highest SMR was observed in the youngest age groups depending, of course, on the extremely low risk for death in this group within a 1-year time interval. It is important to keep in mind that SMRs for different anatomical locations should only be compared within each age group and not between age groups. As expected, the absolute mortality rates demonstrated a reversed pattern, with highest absolute mortality rates observed after a fracture in the older age groups. The femur diaphysis fractures demonstrated the highest or second highest SMRs of all locations within three of the four age groups, with exception of the oldest age group, at both studied time points. The percentage of patients who died within one year after sustaining a femur diaphysis fracture was, of course, much higher for the older patients (around 30%) compared with patients in the younger age groups (1–2%).However, the SMR was 147 for the youngest patients and 9 for patients > 80 years old. Increased mortality for femur diaphysis fracture patients has previously been reported in several studies with different age selections, In an age group of 65 years and younger, Sommersalo et al. showed that femoral diaphysis fractures had the highest mortality rate among fracture locations of the lower extremities, which is in agreement with findings from the present study. In addition, the other fracture locations of the femur (proximal and distal fractures) were among the fracture locations with the highest SMRs within all age groups at both studied time points. Regardless of underlying reasons, which may vary within different age groups, the findings in the present study stress the importance of the increase in mortality risk after sustaining any type of femur fracture, independent of patient age. In addition to femur fractures, other fractures with high SMRs in the lower extremities or in close proximity, were tibia diaphysis, acetabular, and pelvic fractures. For tibia diaphysis fractures, the risk increase was most pronounced in the older ages compared with other fractures within each age group even if the SMRs were highest in the youngest age group. For the oldest age group, the mortality risk following tibia diaphysis fractures was similar to that of proximal femur fractures. For pelvic and acetabular fractures, the SMRs were relatively high for all age groups, however the acetabular fractures were relatively few and thus with less reliable results. Overall, in all age groups only a few of the fracture locations in the upper extremities demonstrated high SMRs and low absolute mortality rates compared with fractures of the axial skeletal and the lower extremities. However, humerus diaphysis fractures were among the five fracture locations with the highest SMRs at both time points in all age groups and, interestingly, were comparable to proximal femur fractures regarding SMRs within all age groups, at both time points. There has recently been a detailed report published on the SMR of proximal humerus fractures, based on data from the same register as the present study, In previous studies the absolute mortality rate for proximal humerus has been in accordance with the findings in the present study, with about 10% in patients > 65 years at 1 year post-fracture, An observation when comparing age groups was that differences in SMRs for different fracture locations within each age group were less pronounced in the older age groups, e.g., the fracture location seemed to play less of a role in relation to mortality risk than in younger patients. In the oldest patient group, fractures in any location, except for the most peripheral parts of the extremities, were associated with an SMR of similar magnitude (SMR around 2 at 1 year after fracture) indicating that most fractures in this age group may be considered as frailty markers, It is worth noting that the much lower number of fractures, as well as the low mortality rates, in the youngest patients makes the results for this group less reliable (large confidence intervals) than in the older age groups and need to be interpreted with some caution. The strength of the present study was that the mortality rate and SMR could be described for the different fracture locations in different age groups for an adult population. A limitation was, despite the overall large number of included fractures, the relatively low number of fractures in certain locations and age groups, resulting in less reliable figures for some combinations of age and fracture locations. Another limitation was that each fracture was studied in relation to mortality independently if the patient suffered from multiple fractures; however, in 97% of the registered injury occasions only one fracture was registered. In summary, all types of femur fractures resulted in high SMRs within each of the four age groups. Other fractures with high SMRs within each age group at both investigated time points were fractures of humerus diaphysis, acetabulum, pelvis, and spine. Bearing this in mind, patients with these fractures should be treated with caution. In addition, it can be concluded that, regardless of age, any type of femur fracture and humerus diaphysis fracture is associated with the highest absolute mortality figures within the respective age groups. It is important to remember that, in the oldest patients, sustaining almost any fracture results in twice as many deaths as compared with what is expected within a year. Awareness of both SMRs and absolute mortality rates for different fracture locations within different age groups are of importance in the prioritizing and organization of care for these patients.

What is the survival rate for pneumonia after surgery?

Background – Every year, more than 300 million patients worldwide undergo surgery ( 1 ). Estimates of procedure-related mortality in surgical patients range from 1 to 4%, of which more than one-fifth are due to perioperative complications, with an incidence ranging from 3 to 16% ( 1, 2 ).

Studies have shown ( 3 ) that almost half of perioperative complications can be effectively prevented, and the current incidence of permanent disability or death caused by these complications still accounts for 0.4% to 0.8%. Even with timely treatment, related complications will still reduce the long-term survival time of surgical patients.

Postoperative pneumonia (POP) is one most common complication of these and it is defined as hospital-acquired pneumonia or ventilator-associated pneumonia in post-surgical patients. Currently, postoperative pneumonia has the highest incidence of hospital-acquired pneumonia in the world, accounting for approximately 50% of all nosocomial pneumonias, with an incidence of 1.5 to 15.8% ( 4 – 7 ).

Postoperative pneumonia can adversely affect the outcomes of surgical patients and may even threaten their lives. Mortality related to postoperative pneumonia among surgical patients has been reported to range from 20 to 50%, and the mortality rate varies by the type of surgery ( 8 ). Studies have shown that the fatality rate caused by postoperative pneumonia can be up to 9–50%, and even after risk adjustment, the patients’ 5-year survival rate after surgery is reduced by 66% ( 9 ).

Among the remaining survivors, there is also evidence that postoperative pneumonia adversely affects the patients’ early postoperative recovery and late quality of life. In addition, postoperative pneumonia can significantly prolong the hospital stay of surgical patients and significantly increase their postoperative ICU occupancy rate, readmission rate, reoperation rate and mortality rate ( 8, 9 ), which greatly aggravate the burden of medical expenses of patients and leads to an average increase by approximately 2–10 times of additional medical expenses ( 5, 9 ).

Therefore, it is obviously worthwhile to identify the perioperative risk factors for postoperative pneumonia and investigate the distribution of causative bacteria. The result would suggest the measures for risk reduction through action on modifiable factors, or increase vigilance in the presence of non–modifiable conditions.

The result of causative bacteria could also aid in selection of antibiotics for post-infection treatment especially considered against the worldwide escalation of infection caused by multidrug resistant microorganisms. Our primary aim was to identify perioperative risk factors and outcomes of postoperative pneumonia.

Does walking pneumonia return?

How is walking pneumonia treated? – Walking pneumonia treatment depends on its cause. If a healthcare provider suspects that you have walking pneumonia and its cause is bacteria, they may prescribe antibiotics. They may prescribe the following:

Macrolide antibiotics, Macrolide drugs include azithromycin (Zithromax®) and clarithromycin (Biaxin®). They’re appropriate for children and adults. Fluoroquinolones, Fluoroquinolones include ciprofloxacin (Cipro®) and levofloxacin (Levaquin®). Providers usually don’t prescribe fluoroquinolones to young children. Tetracyclines, Tetracyclines include doxycycline (Acticlate®) and tetracycline (Emtet-500®). They’re appropriate for adults and older children.

If a provider prescribes antibiotics, be sure to finish the full course, even if you feel better. If you don’t, walking pneumonia may come back and be more difficult to treat. If you have walking pneumonia as a result of a virus or another cause, you have to let the illness run its course.

1. A provider may recommend over-the-counter (OTC) medications to help relieve nasal congestion, cough and mucus buildup in your chest.
2. You can help open your airways by drinking plenty of warm fluids, using a humidifier or taking a hot bath or shower.
3. If you have a fever, it’s a good idea to drink more fluids and rest.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can also help reduce your fever. Not everyone can take NSAIDs, so it’s a good idea to check with a provider before you take them. Walking pneumonia is usually mild and doesn’t require hospitalization.

Why is pneumonia a risk after surgery?

What causes postoperative pneumonia? – There is a range of reasons why a patient might develop postoperative pneumonia. The first is that following surgery and illness, patients tend to be immunocompromised. This makes them more vulnerable to infection that can lead to pneumonia.

Pseudomonas species Klebsiella species Enterobacter species

Staphylococcus aureus is the most common gram-positive bacterial cause of postoperative pneumonia.

Why is it easy to get pneumonia after surgery?

Why Do Patients Develop Postoperative Pneumonia? – The various circumstances surrounding surgery tend to make patients more likely to develop pneumonia, For example, many people who undergo surgery are doing so because they’re sick, and because their immune systems are already compromised due to this illness, they’re more prone to developing an infection.

Why are people prone to pneumonia after surgery?

What causes postoperative pneumonia? – There is a range of reasons why a patient might develop postoperative pneumonia. The first is that following surgery and illness, patients tend to be immunocompromised. This makes them more vulnerable to infection that can lead to pneumonia.

Pseudomonas species Klebsiella species Enterobacter species

Staphylococcus aureus is the most common gram-positive bacterial cause of postoperative pneumonia.

Why do patients get pneumonia after surgery?

Causes – Pneumonia is caused by a viral, bacterial or fungal infection. These germs can enter your lungs through medical equipment. The types of germs found in hospitals can be resistant to drugs, and that makes them very dangerous. You can also be exposed to germs at home as you recover from your surgery.

What causes infection after hip surgery?

Types of Infection after Hip Replacement and Knee Replacement – After a hip or knee replacement, you may develop an infection around the scar or surgical wound or deep around the artificial implant. Infections occur because of the bacteria that live all around us.

Cuts or other wounds in your skin Colorectal procedures Dental procedures Other viral, bacterial, fungal, or parasitic infections Surgical incisions from other procedures