{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T17:44:33Z","timestamp":1778262273493,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T00:00:00Z","timestamp":1603843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To report outcomes of geriatric patients undergoing hip fracture surgery or arthroplasty with or without preoperative pneumonia and to evaluate the influence of pneumonia severity on patient prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this single center retrospective study, we included geriatric patients (\u226560\u2009years old) who had undergone hip fracture surgery or arthroplasty at Peking University People's Hospital from January 2008 to September 2018. Patients with fractures caused by neoplasms or patients with incomplete clinical data were excluded. Using logistic regression and the CURB\u201065 (confusion, uremia, respiratory rate, blood pressure, and age\u2009\u226565\u2009years) score as a prediction tool of 1\u2010year mortality, the effect of preoperative pneumonia on 1\u2010year mortality was evaluated. Survival of patients with different response to pneumonia\u2010specific therapy and survival of patients with different pneumonia severity (evaluated with CURB\u201065 score) were analyzed using Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1386 patients were included; among them, 109 patients (7.86%) were diagnosed with preoperative pneumonia. Outcomes were evaluated in August 2019 (at least 1\u2009year after surgery for all patients). Compared to patients without preoperative pneumonia, patients with this condition had higher 30\u2010day mortality (11.9% <jats:italic>vs<\/jats:italic> 5%, <jats:italic>P<\/jats:italic> = 0.002) and 1\u2010year mortality rates (33.9% <jats:italic>vs<\/jats:italic> 16.3%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and higher incidence of acute heart failure (7.3% <jats:italic>vs<\/jats:italic> 3.4%, <jats:italic>P<\/jats:italic> = 0.034) and acute kidney injury (5.5% <jats:italic>vs<\/jats:italic> 1.8%, <jats:italic>P<\/jats:italic> = 0.009). In multivariate regression, preoperative pneumonia was identified as an independent predictor of 1\u2010year mortality (odds ratio [<jats:italic>OR<\/jats:italic>], 1.45; 95% confidence interval [<jats:italic>CI<\/jats:italic>] 1.39\u20133.52; <jats:italic>P<\/jats:italic> = 0.021), with other factors including age (\u226584\u2009years, <jats:italic>OR<\/jats:italic>, 1.46; 95% <jats:italic>CI<\/jats:italic> 1.08\u20131.60; <jats:italic>P<\/jats:italic> = 0.027), body mass index (&lt;18.5 kg\/m<jats:sup>2<\/jats:sup>, <jats:italic>OR<\/jats:italic> 2.23; 95% <jats:italic>CI<\/jats:italic> 1.52\u20133.17, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), anesthesia type (regional, <jats:italic>OR<\/jats:italic> 0.87; 95% <jats:italic>CI<\/jats:italic> 0.19\u20130.97, <jats:italic>P<\/jats:italic> = 0.042), preoperative pneumonia (<jats:italic>OR<\/jats:italic> 1.45; 95% <jats:italic>CI<\/jats:italic> 1.39\u20133.52; <jats:italic>P<\/jats:italic> = 0.002), congestive heart failure (<jats:italic>OR<\/jats:italic> 2.05, 95% <jats:italic>CI<\/jats:italic> 1.57\u20136.21, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), chronic kidney disease (<jats:italic>OR<\/jats:italic> 1.73; 95% <jats:italic>CI<\/jats:italic> 1.50\u20132.62; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). There was a trend of increased 1\u2010year mortality as the CURB\u201065 score elevated (<jats:italic>P<\/jats:italic> for trend = 0.006). Cox regression reveals a higher risk of mortality in patient with preoperative pneumonia, especially in patients with no radiologic improvements after therapy (log\u2010rank, <jats:italic>P<\/jats:italic> = 0.035). Analysis of the impact of pneumonia severity on patient survival using Cox regression reveals that a CURB\u201065 score \u22653 indicated a lower rate of survival (CURB\u201065 score of 3: hazard ratio [<jats:italic>HR<\/jats:italic>] 3.12, 95% <jats:italic>CI<\/jats:italic> 1.39\u20137.03, <jats:italic>P<\/jats:italic> = 0.006; score of 4: <jats:italic>HR<\/jats:italic> 3.41, 95% <jats:italic>CI<\/jats:italic> 1.69\u20136.92, <jats:italic>P<\/jats:italic> = 0.001; score of 5: <jats:italic>HR<\/jats:italic> 6.28, 95% <jats:italic>CI<\/jats:italic> 2.95\u201313.35, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this single center retrospective study, preoperative pneumonia was identified as an independent risk factor of 1\u2010year mortality in geriatric patients undergoing hip fracture surgery or arthroplasty. A CURB\u201065 score \u22653 indicated a higher risk of mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12830","type":"journal-article","created":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T13:11:40Z","timestamp":1603890700000},"page":"1890-1899","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Prognostic Implications of Preoperative Pneumonia for Geriatric Patients Undergoing Hip Fracture Surgery or Arthroplasty"],"prefix":"10.1111","volume":"12","author":[{"given":"Jia\u2010wei","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei\u2010xun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"You\u2010zhong","family":"An","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0757-9110","authenticated-orcid":false,"given":"Bao\u2010guo","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,10,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01623184"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(93)90218-E"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02982665"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-016-0332-0"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-006-0172-4"},{"key":"e_1_2_6_7_1","first-page":"1","article-title":"Overview: surveillance for selected public health indicators affecting older adults\u2013United States","volume":"48","author":"Blackman DK","year":"1999","journal-title":"MMWR CDC Surveill Summ"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12512"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12542"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38643.663843.55"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2019.07.023"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/18.4.501"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)15021-0"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-2068-1"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d3304"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2003.tb05653.x"},{"key":"e_1_2_6_17_1","doi-asserted-by":"crossref","first-page":"e11845","DOI":"10.1097\/MD.0000000000011845","article-title":"Reduction in the incidence of pneumonia in elderly patients after hip fracture surgery: An inpatient pulmonary rehabilitation program","volume":"97","author":"Chang SC","year":"2018","journal-title":"Medicine"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200008000-00015"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-018-4539-4"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3409-1"},{"key":"e_1_2_6_21_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/00003086-198406000-00008","article-title":"Hip fracture mortality. 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