Implementation of a pneumonia prevention protocol to decrease the incidence of postoperative pneumonia in patients after hip fracture surgery

• Published in: Injury 2022-08, Vol.53 (8), p.2818-2822
• Main Authors: Geerds, M.A.J., Folbert, E.C., Visschedijk, S.F.M., Klunder, M.B., Vollenbroek-Hutten, M.M.R., Hegeman, J.H.
• Format: Article
• Language: English
• Subjects: elderly patients; hip fracture; pneumonia; prevention
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.06.017

•The proactive postoperative pneumonia prevention protocol with oral care, early mobilization and intensified physical therapy, reveals promising results in the prevention of postoperative pneumonia after hip fracture surgery in elderly patients.•After implementation of the proactive postoperative pneumonia prevention protocol the incidence of postoperative pneumonia was significantly lower (6.7 percentage points) in the group receiving the proactive postoperative pneumonia prevention protocol (17.3% in the historical control cohort vs 10.6% in the intervention cohort; p=0.033).•The proactive postoperative pneumonia prevention protocol is considered as minimally disruptive to daily routine activities, thus lowering the barriers to their sustainable implementation and increasing the protocol's potential. Postoperative pneumonia is among the most common complications in elderly patients after hip fracture surgery. We implemented a proactive postoperative pneumonia prevention protocol and analyzed the incidence of postoperative pneumonia in elderly patients (≥70 years of age) receiving this protocol after hip fracture surgery versus those receiving usual care before the protocol's implementation at our institution. From November 2018 to October 2019, the proactive postoperative pneumonia prevention protocol was implemented. The treatment included intensified physical therapy, postoperative pulmonary exercises and oral care, in addition to the usual surgical treatment for elderly patients with hip fracture. The intervention cohort data were compared with a historical control cohort treated from July 2017 to June 2018. The primary outcome of this study was the incidence of postoperative pneumonia in both groups, diagnosed according to the presence of two of three of the following: elevated infection parameters, radiologic examination confirmation of pneumonia of the chest or clinical suspicion. A total of 494 patients (n= 249 in the historical control cohort and n=245 in the intervention cohort) were included. A total of 69 patients developed postoperative pneumonia. The incidence of postoperative pneumonia was significantly lower (6.7 percentage points) in the group receiving the proactive postoperative pneumonia prevention protocol (17.3% in the historical control cohort vs 10.6% in the intervention cohort; p=0.033). A proactive postoperative pneumonia prevention protocol showed promise in decreasing the occurrence of postoperative pneumonia after hip fractur