| Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc |
| Journal website http://www.jocmr.org |
Review
Volume 9, Number 6, June 2017, pages 466-475
The Epidemiology and Risk Factors for Postoperative Pneumonia
Tables
| Author | N | Type of study | Procedure | Incidence | Risk factors/outcomes | Surgical specialty |
|---|---|---|---|---|---|---|
| POD: postoperative day; MELD: model for end-stage liver disease; BMI: body mass index; COPD: chronic obstructive pulmonary disorder; ASA: American Society of Anesthesiologists; OR: operating room; RF: risk factor. | ||||||
| Pessaux et al [12] | 555 | Prospective | Partial hepatectomy | 15 (2.7%) | Risk factors: nasogastric tube, transfusion, diabetes | General |
| Nobili et al [13] | 555 | Retrospective | Hepatectomy | 72 (13%) | Risk factors: blood transfusion, diabetes, atrial fibrillation | General |
| Choudhuri et al [14] | 117 | Retrospective | Hepatic resection | 12 (10.3%) | Risk factors: age > 70, smoking, diabetes, surgical complications, blood transfusion | General |
| Sakamoto et al [15] | 294 | Retrospective | Hepatectomy | 24 (8.2%) | Risk factors: Brinkman index ≥ 400, bacteria in sputum POD1 | General |
| Siniscalchi et al [16] | 242 | Retrospective | Orthotopic liver transplantation (OLT) | 18 (7.4%) | Risk factors: terlipressin use, blood transfusion, mechanical ventilation duration, preoperative hospitalization, MELD score | General |
| Kawanishi et al [17] | 504 | Retrospective | Endoscopic hemostasis | 24 (4.8%) | Risk factors: age > 75, procedure duration > 30 min, hemodialysis, history of stroke | General |
| Jimbo et al [18] | 105 | Retrospective | Esophagectomy | 21 (20%) | Slight association of endotracheal sputum culture + pneumonia | General |
| Booka et al [19] | 284 | Retrospective | Esophagectomy | 64 (22.5%) | Pneumonia predictor for poor survival | General |
| Okamura et al [20] | 342 | Retrospective | Esophagectomy | 99 (28.9%) | Risk factors: higher lung age, lower BMI | General |
| Wei et al [21] | 216 | Retrospective | Esophagectomy | 17 (10.24%) | Risk factor: low peak expiratory flow | General |
| Soutome et al [22] | 280 | Retrospective | Esophageal resection | 65 (23.2%) | Risk factors: diabetes, dysphagia, no pre-operative oral care | General |
| Kiuchi et al [23] | 1415 | Retrospective | Gastrectomy (gastric cancer) | 31 (2.2%) | Risk factors: age > 65, albumin < 3.0, stage ≥ II, hypertension, total gastrectomy | General |
| Miki et al [24] | 750 | Retrospective | Gastrectomy (gastric cancer) | 32 (4.3%) | Risk factors: age > 75, diabetes, impaired respiratory function, blood transfusion | General |
| Ntutumu et al [25] | 1,205 | Retrospective | Laparoscopic gastrectomy | 56 (4.7%) | Risk factors: age, total gastrectomy, time to first diet | General |
| Nagle et al [26] | 1,090/436 | Retrospective | Pancreaticoduodenectomy/distal pancreatectomy | 47/1,090 (4.3%) 11/436 (2.5%) | Risk factors: delayed gastric emptying, O2 on POD3, COPD | General |
| Kim et al [27] | 387 | Retrospective | Abdominal surgery w/COPD as RF | COPD + → 14/117 (12%); control → 13/86 (15.1%) | Risk factor: severe COPD Mild-to-moderate COPD not a risk factor | General |
| Pasin et al [28] | 269,637 | Systematic review and meta-analysis | Open abdominal aortic surgery | 7.30% | Increased mortality, more frequent with urgent procedures | General |
| Studer et al [29] | 70 | Retrospective | Abdominal surgery | Mortality 27% | Risk factors: old age, bilateral pneumonia, blood transfusion | General |
| Yang et al [30] | 165,196 | Retrospective | Major abdominal surgery | 3.20% | Risk factors: esophageal surgery, ASA class, dependent functional status, prolonged OR time, age ≥ 80, severe COPD, preoperative shock, ascites, smoking | General |
| Antoniou et al [31] | 185/328 | Retrospective | Lap vs. open surgery in obese patients | 0.5% → Lap 1.1% → open | Lower incidence and mortality in lap | General |
| Spadaro et al [32] | 330 | Prospective observational | Major abdominal surgery w/ expiratory flow limitation as RF | Limited flow → 5% likely to have pneumonia | Correlation with pneumonia and expiratory flow limitation | General |
| Chen et al [33] | 5,431 | Retrospective | Abdominal surgery | 86 (1.58%) | Risk factors: age ≥ 70, upper abdominal surgery, surgery > 3 h | General |
| Author | N | Type of study | Procedure | Incidence | Risk factors/outcomes | Surgical specialty |
|---|---|---|---|---|---|---|
| CABG: coronary artery bypass graft; RBC: red blood cell; CT: cardiothoracic; CRF: chronic renal failure; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; PVC: polyvinyl chloride; LOS: length of stay; ICU: intensive care unit; NSCLC: non-small cell lung cancer; WBC: white blood cell. | ||||||
| Strobel et al [34] | 16,084 | Observational | CABG | 531 (3.30%) | Developed a model of 17 pre-operative factors that may predict postoperative pneumonia | CT |
| Likosky et al [35] | 16,182 | Retrospective | CABG | 576 (3.6%) | RBC transfusion increase risk | CT |
| Vera Urquiza R et al [36] | 211 | Prospective | Cardiac surgery | 31 (14.6%) | Risk factors: hypertension, CRF, re-intubation, extubation after 6 h | CT |
| Kilic et al [37] | 6,222 | Retrospective | Cardiac surgery | 282 (4.5%) | Created 33-point risk score Risk factors: age, chronic lung disease, peripheral vascular disease, cardiopulmonary bypass time, intraoperative red blood cell transfusion, and pre- or intraoperative intra-aortic balloon pump | CT |
| Allou et al [38] | 7,349 | Retrospective | Cardiac surgery | 257 (3.5%) | Risk factors: CHF, age, diabetes, time to pneumonia onset | CT |
| Poelaert et al [39] | 136 | Retrospective | Cardiac surgery | 43 (32%) | Risk Factors: mechanical ventilation > 16.6 h, PVC endotracheal tube cuff | CT |
| Miyata et al [40] | 123 | Prospective | Cardiovascular surgery | 12 (9.8%) | Risk factors: cerebrovascular disorder, new neurologic deficit postoperatively | CT |
| Stephan et al [41] | 105 | Prospective observational | Cardiothoracic surgery | 57 (54.3%) | Fiberoptic bronchoscopic bronchoalveolar lavage has most sensitive culture | CT |
| O’Keefe et al [42] | 185 | Retrospective | Cardiac surgery | 39 (7%) | Antibiotics are being given even when cultures are negative | CT |
| Lugg et al [43] | 670 regional thoracic center | Prospective observational | Lung resection | 86 (13%) | Independent risk factors for development of pneumonia: COPD and smoking. Pneumonia patients had longer LOS and higher rates of ICU admissions. | CT |
| Simonsen et al [44] | 7,479 | Retrospective | Lung cancer surgery | 268 (3.6%) | Risk factors: age ≥ 80 years, previous pneumonia, obesity, chronic pulmonary disease, alcoholism, atrial fibrillation | CT |
| Wang et al [45] | 511 | Retrospective | Lung cancer resection | 15 (2.9%) | Risk factor: age > 60 years, squamous cell carcinoma | CT |
| Kobayashi et al [46] | 941 | Retrospective | Lung cancer resection | 137 (14.6%) | Postoperative pyothorax leads to acute exacerbation of pneumonia, majority male | CT |
| Lai et al [47] | 421 | Retrospective | Lobectomy in stage I NSCLC | 37 (8.8%) | Risk factors: COPD, low WBC count | CT |
| Author | N | Type of study | Procedure | Incidence | Risk factors/outcomes | Surgical specialty |
|---|---|---|---|---|---|---|
| BKA: below knee amputation; AKA: above knee amputation; TKA: total knee arthroplasty. | ||||||
| Karam et al [48] | 6,839 | Retrospective | BKA or AKA | 274 (4%) | Mortality: 87 (32%) | Orthopedic |
| Song et al [49] | 111 | Prospective | TKA | 16 (14.4%) | Risk factors: acute hypoxemia, lower BMI, transfusion | Orthopedic |
| Lv et al [50] | 1,429 | Retrospective | Hip fracture surgery | 70 (4.9%) | Risk factors: advanced age, anemia, diabetes, prior stroke, number of comorbidities, ASA score ≥ III, and some laboratory biomarkers | Orthopedic |
| Bohl et al [51] | 11,353 | Retrospective | Anterior cervical decompression and fusion | 0.45% | Risk factors: age, dependent functional status, COPD, longer operation | Spine |
| Bohl et al [52] | 12,428 | Retrospective (NSQUIP) | Lumbar fusion | 0.59% | Risk factors: COPD, diabetes, more operative levels Also higher rate of sepsis and mortality | Spine |
| Author | N | Type of study | Procedure | Incidence | Risk factors/outcomes | Surgical specialty |
|---|---|---|---|---|---|---|
| TOO: transoral odontoidectomy; PF: posterior fixation; PPC: postoperative pulmonary complication. | ||||||
| Li et al [53] | 482 | Retrospective | Oral cancer surgery | 95 (19.7%) | Risk factors: male, long duration of tracheostomy | Head and neck |
| Marda et al [54] | 178 | Retrospective | TOO and PF | 10 (5.6) | Risk factor: blood transfusion | Head and neck |
| Loeffelbein et al [55] | 648 | Retrospective | Major oral and maxillofacial surgery | 18.8% PPCs (pneumonia, atelectasis, pleural effusions, pulmonary embolism, pulmonary edema, pneumothorax or respiratory failure) | Risk factors: male, advanced age, BMI | Head and neck |
| Damian et al [56] | 110 | Retrospective | Head and neck cancer surgery | 10 (9.1%) | Patients required longer ventilation support and frequent ICU admissions | Head and neck |
| Desai et al [57] | 15,317 | Retrospective | Pituitary surgery | 98 (0.6%) | Transfrontal has higher incidence than transsphenoidal | Head and neck |
| Savardekar et al [58] | 103 | Prospective | Microsurgical clipping of aneurysm | 28 (27.2%) | Mortality: 10 (9.7%) Risk factors: postoperative intubation > 48 h, tracheostomy, ICU stay > 5 days | Head and neck |