{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:12:53Z","timestamp":1790205173672,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T00:00:00Z","timestamp":1667260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: Acute respiratory infection (ARI) can significantly reduce postoperative quality of life and impair the recovery of older adult patients with lower-limb fractures, and its relationship with methods of anesthesia remains inconclusive. Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, this study examined the data of patients who received surgical management for lower-limb fractures and compared those who underwent general anesthesia (GA) with those who underwent regional anesthesia (RA) in terms of their incidence of acute upper and lower respiratory infection during the one-month postoperative period. The study also identified related risk factors. Material and Methods: Approximately two million patients were randomly sampled from the NHIRD registry. We identified and enrolled patients with lower-limb fractures who were over 60 years old and underwent GA or RA during surgeries conducted between 2010 and 2017. We divided these patients into two groups for further analysis. The outcome of this study was the development of ARI during the one-month postoperative period. Results: In total, 45,032 patients (GA group, 19,580 patients; RA group, 25,452 patients) with a mean age of 75.0 \u00b1 8.9 years were included in our study. The incidence of postoperative ARI within one month of surgery was 8.0% (1562 patients) in the GA group and 9.5% (2412 patients) in the RA group, revealing a significant difference. The significant risk factors for the incidence of ARI were the application of RA for surgery, older age, hypertension, liver disease, and chronic obstructive pulmonary disease (COPD). A subgroup analysis revealed that the RA method was associated with a significantly higher ARI incidence relative to the GA method among patients aged between 60 and 80 years, among male patients, among the patients with or without any comorbidity and among the patients without COPD. Conclusion: The incidence of postoperative ARI within one month of surgery was higher among older patients with lower-limb fractures who received RA for surgery than among those who received GA for surgery. The other major risk factors for ARI were older age, hypertension, liver disease, and COPD. Therefore, we should focus on patients with a high risk of developing ARI, especially during the COVID-19 pandemic.<\/jats:p>","DOI":"10.3390\/ijerph192114260","type":"journal-article","created":{"date-parts":[[2022,11,1]],"date-time":"2022-11-01T06:01:28Z","timestamp":1667282488000},"page":"14260","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Incidence of Acute Respiratory Infection Was Higher in the Older Adults with Lower Limb Fracture Who Receive Spinal Anesthesia Than Those Who Receive General Anesthesia"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6154-2167","authenticated-orcid":false,"given":"Kuang-Ting","family":"Yeh","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"},{"name":"Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan"},{"name":"School of Medicine, Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Tien","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"},{"name":"School of Medicine, Tzu Chi University, Hualien 970374, Taiwan"},{"name":"Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6624-5893","authenticated-orcid":false,"given":"Ru-Ping","family":"Lee","sequence":"additional","affiliation":[{"name":"Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8005-9958","authenticated-orcid":false,"given":"Jen-Hung","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2029-5550","authenticated-orcid":false,"given":"Tsung-Ying","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 970374, Taiwan"},{"name":"Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S118","DOI":"10.1016\/j.injury.2020.04.050","article-title":"Management of Lower Extremity Fractures in the Elderly: A Focus on Post-Operative Rehabilitation","volume":"51","author":"Donohoe","year":"2020","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1177\/1938640020908428","article-title":"Timing of Early Complications Following Open Reduction and Internal Fixation of Closed Ankle Fractures","volume":"14","author":"Bohl","year":"2021","journal-title":"Foot Ankle Spec."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1007\/s00068-021-01772-3","article-title":"Pelvic fractures in severely injured elderly: A double-adjustment propensity score matched analysis from a level I trauma center","volume":"48","author":"Gogna","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Yeh, H.W., Yeh, L.T., Chou, Y.H., Yang, S.F., Ho, S.W., Yeh, Y.T., Yeh, Y.T., Wang, Y.H., Chan, C.H., and Yeh, C.B. (2019). Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study. Int. J. Environ. Res. Public Health., 17.","DOI":"10.3390\/ijerph17010033"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1056\/NEJMoa2113514","article-title":"Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults","volume":"385","author":"Neuman","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_6","unstructured":"Smith, G., D\u2019Cruz, J.R., Rondeau, B., and Goldman, J. (2022, June 07). General Anesthesia for Surgeons, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK493199\/."},{"key":"ref_7","first-page":"111","article-title":"Optimize General Anesthesia for a Dystrophic Epidermolysis Bullosa Patient That Cannot Be Intubated","volume":"58","author":"Chia","year":"2020","journal-title":"Asian J. Anesthesiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e18220","DOI":"10.1097\/MD.0000000000018220","article-title":"Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis","volume":"98","author":"Chen","year":"2019","journal-title":"Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4","DOI":"10.2174\/1874609812666191023130117","article-title":"The Concept of Successful Aging: A Review Article","volume":"13","author":"Estebsari","year":"2020","journal-title":"Curr. Aging Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3000605211043245","DOI":"10.1177\/03000605211043245","article-title":"Factors influencing lower respiratory tract infection in older patients after general anesthesia","volume":"49","author":"Chen","year":"2021","journal-title":"J. Int. Med. Res."},{"key":"ref_11","first-page":"CD000521","article-title":"Anaesthesia for hip fracture surgery in adults","volume":"2","author":"Guay","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"10225536221078622","DOI":"10.1177\/10225536221078622","article-title":"Aspiration pneumonia and anesthesia techniques in hip fracture surgery in elderly patients: A retrospective cohort study using administrative data","volume":"30","author":"Fukuda","year":"2022","journal-title":"J. Orthop. Surg. Hong Kong"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1001\/archinte.162.18.2053","article-title":"Medical complications and outcomes after hip fracture repair","volume":"162","author":"Lawrence","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1213\/00000539-200302000-00051","article-title":"Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival","volume":"96","author":"Manku","year":"2003","journal-title":"Anesth. Analg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s10877-019-00406-9","article-title":"Near-infrared spectroscopy for assessing microcirculation during laparoscopic gynaecological surgery under combined spinal-general anaesthesia or general anaesthesia alone: A randomised controlled trial","volume":"34","author":"Zdravkovic","year":"2020","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Du, H., Tong, X., Sun, X., Shi, Z., Liu, B., Gao, F., Miao, Z., and Zhang, D. (2020). Effect of anesthesia strategy during endovascular therapy on 90-day outcomes in acute basilar artery occlusion: A retrospective observational study. BMC Neurol., 20.","DOI":"10.1186\/s12883-020-01979-8"},{"key":"ref_17","first-page":"4908","article-title":"The etiological characteristics and risk factors of lower respiratory tract infections after general anesthesia and tracheal intubation in elderly patients","volume":"27","author":"Taiping","year":"2017","journal-title":"Chin. J. Nosocom. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1093\/oxfordjournals.bja.a013468","article-title":"General versus regional anaesthesia for hip fracture surgery: A meta-analysis of randomized trials","volume":"84","author":"Urwin","year":"2000","journal-title":"Br. J. Anaesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1016\/j.injury.2018.09.023","article-title":"The influence of anesthetic techniques on postoperative cognitive function in elderly patients undergoing hip fracture surgery: General vs spinal anesthesia","volume":"49","author":"Tzimas","year":"2018","journal-title":"Injury"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1093\/bja\/aem228","article-title":"Cough reflex sensitivity after elective Caesarean section under spinal anaesthesia and after vaginal delivery","volume":"99","author":"Gayat","year":"2007","journal-title":"Br. J. Anaesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jama.2021.22647","article-title":"Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial","volume":"327","author":"Li","year":"2022","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1097\/ACO.0000000000000465","article-title":"Prevention of respiratory complications of the surgical patient: Actionable plan for continued process improvement","volume":"30","author":"Ruscic","year":"2017","journal-title":"Curr. Opin Anaesthesiol."},{"key":"ref_23","first-page":"49","article-title":"Perioperative risk factors for postoperative respiratory failure","volume":"29","author":"Attaallah","year":"2019","journal-title":"J. Perioper. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Yoon, S.H., Kim, B.R., Lee, S.Y., Beom, J., Choi, J.H., and Lim, J.Y. (2021). Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: A retrospective cohort study. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02227-5"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S2213-2600(21)00095-3","article-title":"Association between pre-existing respiratory disease and its treatment, and severe COVID-19: A population cohort study","volume":"9","author":"Aveyard","year":"2021","journal-title":"Lancet Respir. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14260\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:07:13Z","timestamp":1760144833000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,1]]},"references-count":25,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["ijerph192114260"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192114260","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,1]]}}}