Abstract
The incidence of postoperative pulmonary infection (PPI) in major orthopedic surgery in the elderly is high, and have a significant impact on perioperative morbidity and mortality. This study aims to develop and validate a nomogram for predicting PPI in elderly patients undergoing major orthopedic surgery. Data included preoperative variables, surgical and anesthesia factors from total of 814 elderly patients undergoing major orthopedic surgery from January 2018 to October 2021 were retrospectively collected. The primary outcome was PPI. The incidence of PPI in this study was 4.2%. Multivariate logistic regression showed that preoperative pulmonary disease (OR:6.018), cognitive impairment (OR:5.285), intraoperative infusion volume ≥ 1200ml (OR:2.693) were independent risk factors for PPI in elderly orthopedic patients. A nomogram was built with 6 risk factors included gender, preoperative pulmonary disease, cognitive impairment and cerebrovascular disease, intraoperative infusion volume, and postoperative analgesia. The area under the curve (AUC) of the nomogram model was 0.800, the slope was 1.000, and the net benefit of the decision curve analysis (DCA) curve was 0.01–0.60. A nomogram for predicting PPI in elderly patients undergoing major orthopedic surgery with 6 variables, can be used to predict PPI of elderly patients undergoing major orthopedic surgery and identify high risk groups.