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

J Hosp Infect. 2020 Jun;105(2):167-175. doi: 10.1016/j.jhin.2020.03.015. Epub 2020 Mar 19.

Abstract

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.

Keywords: Craniotomy; National surgical quality improvement program; Nomogram; Postoperative pneumonia; Prediction; Risk factor.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Craniotomy / adverse effects*
  • Female
  • Humans
  • Incidence
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nomograms*
  • Pneumonia / etiology*
  • Postoperative Complications / diagnosis*
  • Risk Factors
  • Young Adult