Background

Postoperative pneumonia is the third most common complication in surgical patients. However, little is known regarding pneumonia after craniotomy, which is the most commonly performed surgery in the neurosurgery department.

Aim

To investigate the incidence of pneumonia and its association with the length of hospital stay, identify risk factors, and build a prediction model with nomogram.

Methods

The study population was based on the American College of Surgeons National Surgical Quality Improvement Program 2005–2017. Both multivariate logistic regression models and linear regression models were employed.

Findings

The overall incidence rate of postoperative pneumonia is 3.11% in a total of 57,201 surgeries. The risk factors include age >55, male, lower body mass index, diabetes, functional dependent, ventilator dependence, history of severe chronic obstructive pulmonary disease, hypertension, systemic sepsis, white blood cells >12,000, emergency case, American Society of Anesthesiologists class ≥3, general anesthesia, and total operation time >240 min. Ten featured factors are used in nomogram (C-statistic 0.803). Postoperative pneumonia was associated with extended hospital stay. Compared to other postoperative complications, pneumonia showed the second-highest impact on the extension of hospital stay (4.7 days).

Conclusion

This study identified several preoperative risk factors for postoperative pneumonia after craniotomy, novel factors including male, low BMI warrants further investigation. The novel nomogram could serve as a reliable tool for evaluating postoperative pneumonia risk preoperatively.

中文翻译：

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开颅手术后的肺炎：发生率，危险因素和诺模图预测。

背景

术后肺炎是外科手术患者中第三常见的并发症。然而，对于开颅手术后的肺炎知之甚少，开颅手术是神经外科最常进行的手术。

目标

为了调查肺炎的发生率及其与住院时间的关系，确定危险因素，并建立诺模图预测模型。

方法

研究人群基于美国外科医生学院国家外科手术质量改善计划2005–2017。多元逻辑回归模型和线性回归模型都被采用。

发现

在总共57,201例手术中，术后肺炎的总发病率为3.11％。危险因素包括：年龄> 55岁，男性，下体重指数，糖尿病，功能依赖，呼吸机依赖，严重的慢性阻塞性肺疾病病史，高血压，全身性败血症，白细胞> 12,000，紧急情况，美国麻醉医师学会级≥3，全身麻醉，总手术时间> 240分钟。诺模图中使用了十个特征因子（C统计量0.803）。术后肺炎与住院时间延长有关。与其他术后并发症相比，肺炎对住院时间的延长影响最大（4.7天）。

结论

这项研究确定了开颅术后术后肺炎的几种术前危险因素，包括男性，低BMI在内的新因素值得进一步研究。新的列线图可以作为评估术前术后肺炎风险的可靠工具。