Postoperative pneumonia after craniotomy: incidence, risk factors and prediction with a nomogram

doi:10.1016/j.jhin.2020.03.015

Journal of Hospital Infection

Volume 105, Issue 2, June 2020, Pages 167-175

https://doi.org/10.1016/j.jhin.2020.03.015 Get rights and content

SUMMARY

Background

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

Aim

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

Methods

The study population was based on the American College of Surgeons' National Surgical Quality Improvement Program database from 2005 to 2017. Both multi-variate logistic regression models and linear regression models were employed.

Findings

The overall incidence rate of postoperative pneumonia was 3.11% in a total of 57,201 surgical procedures. Risk factors were age >55 years, male gender, low body mass index (BMI), diabetes, functional dependence, ventilator dependence, history of severe chronic obstructive pulmonary disease, hypertension, systemic sepsis, white blood cell count >12,000, emergency case, American Society of Anesthesiologists class ≥3, general anaesthesia and total surgical time >240 min. Ten featured factors were used in the nomogram (C-statistic=0.803). Postoperative pneumonia was associated with extended hospital stay. Compared with other postoperative complications, pneumonia had the second-highest impact on the extension of hospital stay (by 4.7 days).

Conclusion

This study identified several pre-operative risk factors for postoperative pneumonia after craniotomy. Novel factors including male gender and low BMI warrant further investigation. This novel nomogram could serve as a reliable tool to evaluate the risk of postoperative pneumonia pre-operatively.

Introduction

Postoperative pneumonia is the third most common postoperative complication and is associated with adverse prognosis and short-term mortality [[1], [2], [3]]. Several risk factors, including advanced age, smoking, diabetes, chronic obstructive pulmonary disease (COPD) and functional status, have been found to be associated with postoperative pneumonia among general surgeries and cardiothoracic surgeries [4,5]. However, little is known about the incidence and effect of postoperative pneumonia after craniotomy, the most commonly performed procedure in neurosurgery. Therefore, it is essential to better understand the incidence and risk factors of pneumonia following neurosurgery, and its association with adverse outcomes in order to better inform targeted preventive measures.

A study was undertaken using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2017, including a total of 57,201 craniotomies, to systematically investigate the incidence and risk factors of postoperative pneumonia after craniotomy, as well as its association with length of hospital stay. A nomogram was constructed to predict postoperative pneumonia.

Section snippets

Study population

The study population was based on the ACS-NSQIP database 2005–2017. ACS-NSQIP collects data prospectively for patients undergoing surgical procedures, and tracks the development of complications within 30 days of surgery. Data are collected by trained surgical reviewers using a uniform protocol. Data have been validated externally against physician chart review and used widely in surgical outcome studies [6,7]. In this study, patients who underwent craniotomy were identified using the current

Demographics of study population and risk factors for postoperative pneumonia

In total, 1778 cases of postoperative pneumonia were identified from 57,201 craniotomy procedures, with an incidence rate of 3.11%. The incidence rate of postoperative pneumonia decreased slightly over the study period. As shown in Table I, several risk factors were identified for postoperative pneumonia, including age 56–70 years [odds ratio (OR) 1.27, 95% confidence interval (CI) 1.09–1.49], age >70 years (OR 1.47, 95% CI 1.24–1.75), male gender (OR 1.65, 95% CI 1.49–1.82), BMI <18.5 kg/m²

Discussion

Postoperative pneumonia is the third most common complication in all surgical patients [3]. This study, utilizing a large national database, found that the incidence rate of pneumonia was 3.11% in patients who underwent craniotomy, which is the second most common complication in these patients. This study identified that age >55 years, male gender, low BMI, functional dependence, diabetes, hypertension, history of severe COPD, ventilator dependence, systemic sepsis, WBC count >12,000, emergency

Conflict of interest statement

None declared.

Funding sources

This work was supported by the First Affiliated Hospital of Harbin Medical University Science Foundation (Grant No. 2015B011), the Natural Science Foundation of Heilongjiang Province (Grant No. QC2015108), the National Natural Science Foundation of China (Grant No. 81572482) and the China Postdoctoral Science Foundation (Grant No. 2018M631964).

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Development and Validation of a Nomogram for Predicting Postoperative Pulmonary Infection in Patients Undergoing Lung Surgery
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To develop and validate a nomogram for predicting postoperative pulmonary infection (PPI) in patients undergoing lung surgery.
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Because SDD patients must be limited in their positions to prevent over-drainage [16]. In addition to the position limitation, the lower medical complications at postoperative period might be explained by the fact that only 44.1% of the patients in the SPD group were put under general anesthesia, whereas all of the patients in the SDD group received general anesthesia, which is a significant risk factor for iatrogenic pneumonia after an operation [17]. All cases with SDD insertion were performed under general anesthesia to avoid parenchymal injury from subdural catheter during surgery.
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Postoperative pneumonia is the third most common postoperative complication in surgical patients.38 The ACS-NSQIP data from 2005 to 2017 reveals 1778 cases of postoperative pneumonia from 57,201 craniotomies, with an incidence of 3.11%.38 In our hospital, a standard trend was observed in unplanned reintubation, ventilator dependence, and postoperative pneumonia that was commensurable to the worldwide NSQIP database.
Low-middle-income countries (LMICs) share a substantial proportion of global surgical complications. This is compounded by the seemingly deficient documentation of postsurgical complications and the lack of a national average for comparison. In this context, the implementation of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) that compares hospital performance based on postsurgical complication data provided by a wide array of centers, could be a major initiative in a resource-challenged setting. Implementation of the NSQIP has provenly mitigated postoperative morbidity and mortality across many centers all over the world. To our knowledge, this report is the first from an LMIC to report its postoperative neurosurgical complications in comparison with international benchmarks.
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¹: D. Zhang, H. Zhuo and G. Yang contributed equally to this work.

View full text

Postoperative pneumonia after craniotomy: incidence, risk factors and prediction with a nomogram

SUMMARY

Background

Aim

Methods

Findings

Conclusion

Introduction

Section snippets

Study population

Demographics of study population and risk factors for postoperative pneumonia

Discussion

Conflict of interest statement

Funding sources

J Am Coll Surg

Am J Med

J Vasc Surg

Spine J

Chest

Ann Thorac Surg

The effect of preoperative pneumonia on postsurgical mortality and morbidity: a NSQIP analysis

World J Surg

Long-term results of a postoperative pneumonia prevention program for the inpatient surgical ward

JAMA Surg

The epidemiology and risk factors for postoperative pneumonia

J Clin Med Res

Readmission after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Neurosurgery

Risk of venous thromboembolism and operative duration in patients undergoing neurosurgical procedures

Neurosurgery

Impact of postoperative pneumonia following pituitary surgery

Laryngoscope

A comprehensive study of risk factors for post-operative pneumonia following resection of meningioma

BMC Cancer