Prevalence and associated risk factors of pneumonia following surgery for geriatric osteoporotic fracture: A nationwide cross-sectional study of China.

Postoperative pneumonia (POP) is a common and severe complication following surgery for geriatric osteoporotic fracture (OPF), which warrants close attention as a major global public health issue.  With the growth of global life expectancy, the number of patients who suffer OPF is expected to increase dramatically. However, national data on the incidence of POP and its associated risk factors remain scarce. This study aims to investigate the incidence and independent risk factors of POP among elderly patients with OPF in China via a large-scale cross-sectional survey. From September to November 2023, elderly patients who underwent OPF surgery were recruited for this cross-sectional study via stratified random sampling and a self-designed questionnaire from 594 hospitals in China. Patients' data, including demographic characteristic, medical history and postoperative information, were analyzed with descriptive statistics, and intergroup comparisons were conducted between patients with and without POP. One-to-one propensity score matching (PSM) was applied to baseline clinical datawith a caliper value of  0.01. Independent associated factors related to POP for geriatric OPF were identified by using univariate analysis and multifactorial logistic regression. P < 0.05 was considered a statistically significant difference.A total of 12,496 participants were ultimately included. Among all the patients we investigated, the overall incidence of pneumonia following geriatric OPF surgery was 2.42%. Multifactorial logistic regression analysis showed that history of fracture (OR [odds ratio] 4.483, 95% CI [confidence interval] 2.824-7.117); history of surgery (OR 2.260, 95% CI 1.457-3.507); history of trauma (OR 2.866, 95% CI 1.461-5.625); pre-operative self-care ability (OR 3.254, 95% CI 2.177-4.864); aid of crutches/walkers/wheelchairs (OR 1.692, 95% CI 1.149-2.490); combined chronic obstructive pulmonary disease (COPD) (OR 4.634, 95% CI 1.889-11.369); length of stay (LOS) (OR 1.044, 95% CI 1.016-1.073) were independent risks factors predicting pneumonia for geriatric OPF surgery during hospitalization. Our study identified a non-negligible incidence of POP in elderly patients with OPF. For older adults with a history of fracture, surgery or trauma, comorbid COPD, poor preoperative self-care ability, dependence on walking aids, and longer hospital stays, clinicians should implement evidence-based pneumonia prevention protocols to optimize postoperative recovery.