Injury. 2025 Nov 19;57(2):112897. doi: 10.1016/j.injury.2025.112897. Online ahead of print.
INTRODUCTION: As the number of older adults with hip fractures rises, improving strategies to prevent postoperative pneumonia is crucial in this vulnerable population. This study aims to evaluate the effect of implementing the ICOUGH protocol for the prevention of pneumonia on the incidence of postoperative hospital-acquired pneumonia in geriatric hip fracture patients.
METHODS: This retrospective cohort study included 1342 patients aged ≥ 70 years with operative treatment of a hip fracture between 2021 and 2024. In January 2023, the ICOUGH protocol was implemented, consisting of incentive spirometry, coughing and deep breathing, oral care, early mobilization, patient education, and head-of-bed elevation. A historical control cohort of 646 patients was compared to a post-implementation cohort of 696 patients. The primary outcome was the incidence of hospital-acquired pneumonia. Secondary outcomes included delirium, urinary tract infection, intensive care unit admission, length of stay, and 30-day mortality. Multivariable logistic regression analysis was performed with predetermined covariates.
RESULTS: The incidence of postoperative pneumonia was 8.0 % in the historical cohort, and 4.7 % in the intervention cohort (p = 0.013). Implementation of the ICOUGH protocol was independently associated with a lower risk of developing postoperative hospital-acquired pneumonia (aOR=0.551, 95 % CI=0.347-0.875, p = 0.012). Secondary outcomes showed that delirium was reduced with 7.9 % (p = 0.012) and 30-day mortality was reduced with 1.4 % (p = 0.022) in the intervention group.
CONCLUSION: Implementation of the ICOUGH protocol effectively reduces the incidence of postoperative hospital-acquired pneumonia among geriatric hip fracture patients. This protocol is a practical and minimally invasive strategy, and shows that multidisciplinary, proactive care is effective in preventing postoperative pneumonia.
LEVEL OF EVIDENCE: IIIb.
PubMed:41337952 | DOI:10.1016/j.injury.2025.112897