Association between the duration of skeletal traction and postoperative pneumonia in elderly hip fractures

PURPOSE: This study explores the relationship between preoperative skeletal traction duration and the risk of postoperative pneumonia (POP) in elderly patients with hip fractures. METHODS: This retrospective cohort study analyzed the medical records of patients who underwent preoperative skeletal traction for hip fractures from January 2014 to December 2024 at a tertiary care facility. Patients were divided into four groups according to the quartiles of skeletal traction duration following admission: Q1 (≤ 2 days), Q2 (2–5 days), Q3 (5–6 days), and Q4 (> 6 days). Multifactor logistic regression and propensity score-matched analysis (PSM) were employed to evaluate the relationship between varying durations of preoperative traction and the risk of postoperative pneumonia (POP). Subgroup analyses were conducted to investigate potential interactions. RESULTS: This study included a total of 1,175 patients, with an incidence of postoperative pulmonary infection (POP) of 9.79% (115/1,175). Multiple logistic regression analysis revealed that the risk of POP increased by 80% for each additional day of traction (OR: 1.80, 95% CI: 1.40–2.33, p < 0.01). Patients undergoing traction for 5 days or longer had a 76% increased risk of POP(OR: 1.76, 95% CI: 1.03–3.01, P = 0.03). The findings indicate that patients in group Q4 (> 6 days) (OR = 3.86, 95% CI: 1.33–11.19, p < 0.01) exhibited a significantly elevated risk of postoperative pneumonia compared to those in group Q1 (≤ 2 days). Propensity score matching (PSM) did not change this trend, even after careful adjustment for potential confounders. CONCLUSION: A significant linear dose-response relationship exists between preoperative skeletal traction time and the risk of postoperative pneumonia (POP). An extended duration of traction correlates with an increased risk of postoperative pneumonia (POP).