Predictors of Pulmonary Complications Including Unplanned Intubation Within 30 Days of Femoral Open Reduction and Internal Fixation

Pulmonary complications, such as pneumonia, ventilator dependence, and unplanned intubation, can occur after femoral open reduction and internal fixation (ORIF). This study aimed to identify predictors of pulmonary complications including unplanned intubation within 30 days of femoral open reduction and internal fixation, using the large NSQIP surgical database. # Methods This study used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, which is a de-identified registry that includes the surgical data from over 700 hospitals each year. The NSQIP database was queried for patients undergoing femoral open reduction and internal fixation. Multivariate logistic analysis models identified predictors for postoperative pneumonia, ventilator dependence >48 hours, and unplanned intubation. Predictors examined included demographics, comorbidities (COPD, CHF, renal failure), anesthesia type, ASA classification, and smoking status. Statistical significance was set at p<0.05. # Results Significant independent predictors were found for all 3 pulmonary complications analysed for. Significant independent predictors for postoperative pneumonia included male sex (p<0.0001), COPD (p<0.0001), CHF (p=0.0015), renal failure (p<0.0001), higher ASA class (p<0.0001), and current smoking (p=0.0099). For ventilator dependence >48 hours, significant predictors were COPD (p<0.0001), CHF (p=0.0067), renal failure (p<0.0001), higher ASA class (p<0.0001), smoking (p<0.0001), and epidural or spinal anesthesia compared to general anesthesia (p=0.0017). For unplanned intubation, COPD (p<0.0001), CHF (p=0.0015), renal failure (p<0.0001), and higher ASA class (p<0.0001) were significant predictors. # Conclusion In this database, higher ASA class, COPD, CHF, renal failure, male sex, and smoking were independently associated with increased risk of pulmonary complications after femoral ORIF. This information can help surgeons further understand the pulmonary risks in this procedure, watch high risk patients closer, and help patients lower their risks of pulmonary complications through lifestyle changes, regarding variables like smoking, and drug interventions.