Introduction
The proportion of the elderly population is higher compared to the previous times. The increasing population due to various advancements in medical sciences has led to an increase in the frequency of hip fractures in older populations. One of the serious complications that occur in older people, followed by a hip fracture, is pneumonia. Many studies were carried out to trace the reason for this complication. Certain risk factors were identified. These risk factors should be noted by the surgeons to treat hip fractures and by the patient to be aware and cautious of the risk factors and the following consequences. Older patients with hip fractures are associated with pain, physical limitation, and disability.
What Is Post-operative Pneumonia?
Postoperative pneumonia (POP) is a common complication that can be defined as ventilator-associated pneumonia or hospital-acquired pneumonia in post-surgical patients. This condition constantly affects the surgical outcome of the patient and can also turn out fatal. Recovery and the quality of life are both compromised in individuals. It is a condition occurring after the surgery. A condition in which the patient presents with the following symptoms:
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Fever.
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Chills.
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Cough.
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Reduced blood pressure.
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Increased heart rate.
It is a serious complication that can occur in patients after the surgery as most of them are unconscious after the surgery, and symptoms cannot be recognized. Even though the appearing symptoms sound common, the impact of these symptoms alters the overall recovery of the patient after the surgery. POP necessarily can be dealt with with the help of anti-microbial therapy.
What Are the Diagnostic Criteria for Pulmonary Infection?
The following are the diagnostic criteria for detecting pulmonary infections:
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Elevation of the symptoms related to respiratory diseases like a cough.
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Developing fever after the surgery.
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Physical examination shows signs of altered pulmonary consolidation.
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Presence of patchy infiltration in the chest X-ray.
All the above criteria confirm the diagnosis of pulmonary infection.
What Are the Risk Factors for the Occurrence of Postoperative Pneumonia?
Increased age, emergency surgery, chronic obstructive pulmonary disease, long duration of bed rest, diabetes mellitus, general anesthesia, and prolonged ventilation are significant risk factors that are associated with post-operative pneumonia.
Influence of Age in the Occurrence of Postoperative Pneumonia:
The probability of occurrence of postoperative pulmonary infections is increased with increasing age. As older patients have more underlying comorbidities with reduced immunity, which paves the way for an easy attack by the pathogens along with the surgical stress of hip fracture trauma, declined immunity, further leading to pulmonary infections. It is to be noted that age is not the lone standing factor responsible for postoperative infections, but it is a chief factor associated with other small factors. As surgery cannot be skipped due to increasing age, targeted interventions to reduce postoperative pneumonia risks should be adopted.
Longer Duration of the Surgery:
With the increase in the time of the surgery, there is a higher level of blood loss at the time of surgery, which reduces the patient's resistance and leads to pulmonary infections. When the surgery is performed under general anesthesia, suppression of cough reflex occurs, which will help in the proliferation of the respiratory tract bacteria leading to pneumonia. Hence, the operation time should be shortened to a greater extent.
General Anesthesia:
Local anesthesia does not show a major effect on the spontaneous breathing of the patient and does not suppress the cough reflex. It also avoids any intubation and hence avoids the risk of postoperative complications like pneumonia. Not all surgeries can be done under local anesthesia. General anesthesia is administered, paving a path for compilations. Pathogenic bacterial detection also should be done, and proper antibiotic treatment is advised.
Diabetes:
Diabetic patients are highly prone to pneumonia after surgery. The incidence of postoperative pneumonia is increased when the patient's blood glucose is more than 200 milligrams per deciliter. It occurs due to internal changes inhibiting the effectiveness of the immune response, and the patient is prone to various infections.
Serum Albumin Levels:
It is the common indicator used in the evaluation of nutritional status. It is considered malnutrition when the serum albumin drops below 0.035 ounces per 0.26 gallon and is a risk factor for developing poor post-surgical outcomes. Low body mass index, along with decreased serum albumin levels, leads to malnutrition. In most cases, this alone is an independent factor that results in postoperative pneumonia. The variation in albumin levels can reflect in the body's metabolism, posing an increased risk. Timely infusion of albumin is done to correct these decreased levels of albumin when necessary. As fracture healing, recovery of wounds, and muscle strength need huge protein supplementation, all these procedures are seen to be affected due to malnutrition.
It is suggested to screen an older patient for nutrition before the surgery and provide nutrition supplementations to reduce the risk of infections occurring post-surgery due to malnutrition.
Prolonged Duration of Mechanical Ventilation:
It is also an independent risk factor POP. The duration of ventilation for patients in the intensive care unit usually exceeds 24 hours. Liberating a patient from a ventilator by extubation (removing the endotracheal tube) should be done timely to reduce the occurrence of postoperative pneumonia.
Increased Duration of Bed Rest Over Three Days After the Surgery Is Also a Risk Factor:
When it is necessary for the patient to stay in bed for a longer time, regular expectoration and clearing of the airway secretions should be done. This can be done cautiously to avoid post-surgical complications such as pneumonia.
Conclusion
Several unwanted clinical outcomes are associated with postoperative pneumonia, and the risk factors discussed in this article should be managed to reduce POP. Effective prevention strategies are also implemented by distributing the causative pathogens. The occurrence of postoperative pneumonia in older patients differs with economic levels. On the whole, it can still be stated that it is relatively high and hence needs proper attention. Many reports showed death in patients with POP, so clinical management should be strong enough to reduce the mortality and associated complications.
