Incidence and Risk Factors of Pulmonary Complications Following Femur Fracture Surgery in Patients Aged 80 Years and Older

Purpose: Femur fractures and subsequent surgical procedures are expected to increase with the growth of the older population. Despite the elevated risk of postoperative pulmonary complications in older patients, research focusing on those of very advanced age is limited. We aimed to investigate the incidence and risk factors of pulmonary complications following femur fracture surgery in patients >= 80 years. Patients and Methods: This retrospective cohort study included patients aged >= 80 years admitted to the Orthopedic Surgery Department for femur fracture surgery between 2020 and 2022. We assessed the incidence and risk factors of postoperative pulmonary complications, defined as pneumonia, atelectasis, pulmonary edema, pleural effusion, and venous thromboembolism (VTE). We also examined risk factors for respiratory failure and 90-day mortality, using logistic regression models. Results: The study included 479 patients with a mean age of 86.0 years, and 78.5% were women. Postoperative pulmonary complications occurred in 11.7% of patients, with pleural effusion being the most common (4.4%), followed by pneumonia and atelectasis. The incidence of VTE was 1.5%. Patients who developed pulmonary complications had significantly longer hospital stays (14 days vs 10 days; p<0.001), a greater proportion of patients needing oxygen supplementation (71.4% vs 31.4%; p<0.001), and higher all-cause 90-day mortality (14.3% vs 5.9%; p=0.042). Age, chronic lung disease, and Parkinson's disease were significant risk factors for pulmonary complications. Coronary artery disease, stroke, and prolonged surgery were significantly associated with respiratory failure, whereas internal fixation, coronary artery disease and older age were associated with 90-day mortality. Distal femur fractures were significant risk factors for VTE, while VTE prophylaxis methods were not associated with VTE risk. Conclusion: At least one postoperative pulmonary complication occurred in 11.7% of the participants. Several comorbidities were associated with pulmonary complications, respiratory failure, and 90-day mortality, highlighting the importance of identifying these comorbidities prior to surgery. Plain Language Summary: As global average life expectancy rises, the number of older adults needing femur fracture surgery is also increasing. Advanced age increases the risk of complications after surgery, and many older patients have pre-existing health conditions, making them more likely to experience complications and, in some cases, death. Our study focused on patients aged 80 years or older who underwent femur fracture surgery. We examined the incidence rate of pulmonary complications including venous thromboembolism (blood clots), as well as risk of death within 90 days. Out of the 479 patients studied, 11.7% experienced at least one pulmonary complication after surgery, with pleural effusion being the most common. The overall 90-day death rate was 6.9%, and the rate of venous thromboembolism was 1.5%. Patients who developed pulmonary complications had worse clinical outcomes, including longer hospital stays, extended need for oxygen, and higher death rate within 90 days. We found several health conditions were associated with higher risk of pulmonary complications, such as advanced age, chronic lung diseases, and Parkinson's disease. Similarly, advanced age and coronary artery disease were identified as risk factors for death within 90 days. Our study findings suggest that pulmonary complications are associated with worse outcomes and various pre-existing health conditions are risk factors for them. As more patients with advanced age are expected to undergo femur fracture surgery, it will be important to carefully assess risk factors to help prevent complications.