A Prospective Study on Post-Operative Pulmonary Complications and the Efficacy of Pre-Operative Pulmonary Rehabilitation in Elderly Patients Undergoing Lower Limb Arthroplasty at a Tertiary Care Center in India

Abstract

Background: Post-operative pulmonary complications (PPCs), particularly pneumonia, are significant causes of morbidity, prolonged hospital stay, and increased healthcare costs following major orthopedic surgery. Elderly patients undergoing hip and knee arthroplasty are at a heightened risk. While pre-operative pulmonary rehabilitation (Prehab) is established in cardiothoracic surgery, its role in orthopedic populations, especially in the Indian context, is less explored.

Aim: To determine the incidence and risk factors for post-operative pneumonia in patients undergoing hip/knee arthroplasty and to evaluate the effect of a short-term, intensive pre-operative pulmonary rehabilitation program on reducing PPCs.

Materials and Methods: A prospective cohort study was conducted on 80 patients aged ≥60 years scheduled for elective total hip or knee arthroplasty. Patients were non-randomly allocated into two groups: the Intervention Group (n=40) received a structured 2-week pre-operative pulmonary rehabilitation program, while the Control Group (n=40) received standard pre-operative care. The primary outcome was the incidence of post-operative pneumonia, diagnosed using the Centers for Disease Control and Prevention (CDC) criteria. Secondary outcomes included other PPCs (atelectasis, pleural effusion, respiratory failure), SpO2 levels, post-operative hospital stay, and need for supplemental oxygen.

Results: The overall incidence of post-operative pneumonia was 13.75% (11/80). Multivariate analysis identified age >70 years (OR=4.1, p=0.03), pre-existing COPD (OR=5.8, p=0.008), and general anesthesia (OR=3.9, p=0.04) as significant independent risk factors. The Intervention Group demonstrated a significantly lower incidence of pneumonia compared to the Control Group (5% vs. 22.5%, p=0.02). Furthermore, the Intervention Group had a lower incidence of overall PPCs (10% vs. 35%, p=0.007), shorter mean hospital stay (5.2 ± 1.1 days vs. 7.1 ± 1.8 days, p<0.001), and reduced need for prolonged oxygen therapy.

Conclusion: Post-operative pneumonia is a prevalent complication in elderly Indian patients undergoing lower limb arthroplasty, driven by advanced age, COPD, and anesthetic technique. A short-term, intensive pre-operative pulmonary rehabilitation program is a highly effective and feasible strategy to significantly reduce the incidence of PPCs, improve respiratory outcomes, and decrease hospital length of stay.