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Kumashiro K.1, Oneda N.1, Handa K.1, Shiode H.2
1Kurashiki Central Hospital, Rehabilitation Dept., Kurashiki, Japan, 2Kurashiki Central Hospital, Orthopaedic Surgery, Kurashiki, Japan
Background: Prevention of aspiration pneumonia is crucial for improvement of vital prognoses after hip fracture. It is considered that preoperative exercise therapy and early mobilization after the operation in hip fracture patients may prevent aspiration pneumonia and improve their vital prognoses.
Purpose: To reveal the effects of physical therapy on aspiration pneumonia onset in hip fracture patients.
Methods: The subjects included 459 patients of 65 years old or above with hip fracture.
Presence or absence of aspiration pneumonia, patients factors (age, sex, past medical history of neurological disease, presence or absence of dementia, past medical history of respiratory diseases, and housing situation before injury), medical factors (type of fracture, operative procedure, blood test results at admission [total protein, albumin, hemoglobin], and number of days from the admission until the operation), and physical therapy factors (number of days from the admission until start physical therapy, number of days from the admission until the sitting position, and number of preoperative physical therapy interventions) were investigated retrospectively.
In statistical analyses, subjects were divided into the aspiration pneumonia group and the non-aspiration pneumonia group, and comparisons were made between these groups. A logistic regression analysis was performed using independent variables, with which significant differences had been observed in intergroup comparisons, and presence or absence of aspiration pneumonia as a dependent variable. For the continuous variable, out of the factors determined to be significant in the logistic regression analysis, cutoff value was calculated using ROC curve.
Results: 34 patients developed aspiration pneumonia (incidence 7.4%), and the average number of days from admission until the onset was 4.9, 23 patients (68%) developed preoperatively.
According to the results of the logistic regression analysis, significant item were extracted the housing situation before injury, past medical history of respiratory diseases, the number of days after admission until the start of the sitting position, the albumin level at admission, and sex. As for the cutoff value obtained from the ROC curve for the continuous variable, the number of days from admission until the start of the sitting position was 8.5 days, and the albumin level at admission was 3.75 g/dl.
Conclusion(s): Although the physical therapy factor the number of days after admission until the start of the sitting position was selected as an affecting factor, the cutoff value was 8.5 days, which was 4.9 days longer than the average number of days from admission until the pneumonia onset. This suggests that the start of sitting position was delayed due to the onset of aspiration pneumonia. Meanwhile, the number of cases which developed aspiration pneumonia after the operation was less than that before the operation, the early start of sitting position after the operation might have contributed to prevention of postoperative aspiration pneumonia.
Implications: The risk factors for aspiration pneumonia onset in hip fracture patients were to be living in a nursing center, to have past medical history of respiratory diseases, to have low albumin level at admission (below 3.75 g/dl), and to be male. Early mobilization after hip fracture operation may prevent development of aspiration pneumonia.
Funding acknowledgements: No specially-occurring costs were incurred through the implementation of the study.
Topic: Orthopaedics
Ethics approval: This study was approved by the Kurashiki Central Hospital Clinical Research Review Committee (clinical research application No. 1937).
All authors, affiliations and abstracts have been published as submitted.
