Risks of postoperative respiratory failure in elderly patients after hip surgery: a retrospective study

BACKGROUND: The purpose of this retrospective study was to investigate the determinants of postoperative respiratory failure in elderly patients with hip fracture. METHODS: The subjects of this study were 663 elderly patients who had hip fracture and had been treated with total hip arthroplasty at our hospital from January 2014 to May 2020. According to the occurrence of postoperative respiratory failure, 626 patients with no respiratory failure were retrospectively included in the control group, and 37 cases combined with respiratory failure were enrolled in the PRF group. The clinical and surgical data of the two groups were collected and analyzed to evaluate the determinants of respiratory failure by logistic regression analysis. RESULTS: There were no significant differences in the demographics and baseline variables including age, gender, fracture type and location between the groups (P > 0.05). All patients received hip surgery including total hip arthroplasty (THA), hemiarthroplasty (HA) and internal fixation with PFNA (proximal femoral nail anti-rotation). There were no significant differences in operative time and intraoperative blood loss between the groups (P > 0.05). However, close associations were found between pulmonary hypertension (univariate analysis: OR = 3.792, 95% CI = 1.421–10.203; multivariate analysis: OR = 1.132, 95% CI = 1.003–1.251), obstructive pulmonary disease (OR = 1.119, 95% CI = 1.009–1.238; multivariate analysis: OR = 13.298, 95% CI = 4.021–43.298), bronchiectasis and emphysema (OR = 4.949, 95% CI = 1.919–9.873; multivariate analysis: OR = 11.231, 95% CI = 187.87), and history of respiratory failure (OR = 6.098, 95% CI = 2.012–12.198; multivariate analysis: OR = 8.389, 95% CI = 2.391–21.982) with postoperative respiratory failure (P < 0.05). CONCLUSION: Pulmonary hypertension, abnormal lung texture, obstructive pulmonary disease, bronchiectasis, emphysema, history of respiratory failure, and hypoproteinemia may be risk factors for postoperative respiratory failure in elderly patients with hip fracture.