BACKGROUND Dysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery. METHODS In this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed. RESULTS Dysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]). CONCLUSIONS Dysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.

中文翻译：

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在韩国进行髋部骨折手术的老年患者吞咽困难的患病率，危险因素和预后影响。

背景技术吞咽困难在老年患者例如老年髋部骨折患者中普遍存在，并且与不良预后有关。这项研究调查了（1）基于临床筛查和视频透视吞咽研究（VFSS）进行的吞咽困难的患病率，（2）吞咽困难的危险因素，以及（3）吞咽困难对老年患者（≥65岁）的预后影响）接受髋部骨折手术。方法在这项回顾性研究中，分析了2015年至2018年间接受过髋部骨折手术的393名女性和153名≥65岁男性患者的数据。筛查后被认为有吞咽困难高风险的患者接受了VFSS。为了确定吞咽困难的危险因素，人口统计学因素，美国麻醉医师学会分类，既往病史，已知的吞咽困难危险因素，使用二元logistic回归模型分析与手术相关的因素。通过logistic回归分析得出吞咽困难（包括术后肺炎，重症监护病房（ICU）入院和术后6个月内死亡）的吞咽困难几率（OR）。还分析了术后肺炎与预后不良之间的关系。结果5.3％的髋部骨折患者出现吞咽困难。在多元回归分析中，血清白蛋白水平<3.5 g / dL被确定为吞咽困难的危险因素（OR [95％CI] = 3.13 [1.40，7.01]）。调整后的回归分析表明吞咽困难是术后肺炎的危险因素（OR [95％CI] = 3.12 [1.05，9.27]）。术后肺炎与入ICU显着相关（OR [95％CI] = 4.56 [1.85，11。28]），并在术后6个月内死亡（OR [95％CI] = 2.56 [1.03，6.33]）。结论老年髋部骨折手术患者吞咽困难与术后肺炎相关，这是导致不良结局的危险因素，包括术后6个月内ICU入院和死亡。血清白蛋白水平<3.5 g / dL被确定为吞咽困难的危险因素。因此，应进行诊断测试以检测吞咽困难，尤其是血清白蛋白水平低的患者。最后，应特别注意预防吞咽困难患者的术后并发症。不良结果的风险因素，包括术后6个月内入ICU和死亡。血清白蛋白水平<3.5 g / dL被确定为吞咽困难的危险因素。因此，应进行诊断测试以检测吞咽困难，尤其是血清白蛋白水平低的患者。最后，应特别注意预防吞咽困难患者的术后并发症。不良结果的风险因素，包括术后6个月内入ICU和死亡。血清白蛋白水平<3.5 g / dL被确定为吞咽困难的危险因素。因此，应进行诊断测试以检测吞咽困难，尤其是血清白蛋白水平低的患者。最后，应特别注意预防吞咽困难患者的术后并发症。