Postoperative Pneumonia In Patients Research Articles

Changes in and clinical utility of maximum phonation time and repetitive saliva swallowing test scores after esophagectomy.

Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) have been focused on as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy. In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between August 2020 and July 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia. The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4s, respectively; postoperative MPTs were significantly lower than preoperative MPT. In addition, the MPT of POD 6 was significantly longer than that of POD 3 (P < 0.05). Meanwhile, there were no significant changes in perioperative RSST scores. Overall, 8 of 47 patients (17.0%) developed pneumonia postoperatively. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (odds ratio: 12.6, 95% confidence interval: 1.29-123, P = 0.03) in the multivariate analysis. The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia.

Development and validation of a prediction model for postoperative pneumonia in patients who received spinal surgery: A retrospective study

ObjectivesTo develop and validate a risk prediction model by identifying the preoperative factors associated with an increased risk of pneumonia after spinal surgery. MethodsThis study included patients with spinal disease from two hospitals between January 2021 and June 2023. The patients were divided into the training and validation sets, which were categorized as postoperative pneumonia (POP) or non-POP, respectively. This study identified the independent risk variables for POP using a multivariate logistic regression analysis. A nomogram prediction model was developed and validated using risk factors, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) to assess predictive performance. ResultsFollowing exclusion, 2223 patients from Changzheng Hospital were enrolled in the training set and 357 patients from the No. 905 Hospital of PLA Navy were enrolled in the validation set. Univariate and multivariate logistic regression analyses revealed that operation time, American Society of Anesthesiologists (ASA) grade, smoking, non-wearing of medical masks, lack of preoperative respiratory training, chronic obstructive pulmonary disease (COPD), underlying diseases, and spinal section were risk factors for POP development in patients with spinal diseases. The area under the ROC curve of the training set was 0.950, whereas that of the validation set was 0.879. The model calibration curves demonstrated good agreement, and the DCA indicated a high expected net benefit value. ConclusionThe POP risk prediction model has high accuracy and efficiency in predicting POP in patients with spinal diseases. POP development is influenced by factors such as operation length, ASA grade, smoking, non-wearing of medical masks, lack of preoperative respiratory training, COPD, underlying diseases, and lumbar surgery.

Risk factors for postoperative pneumonia in esophageal cancer patients

Abstract Purpose Patients undergoing surgery for esophageal cancer (EC) frequently experience postoperative pneumonia (POP). POP promotes poor prognosis as well as increased medical costs and longer hospital stays. Therefore, it is desirable to prevent and strictly control high-risk cases to reduce the incidence of pneumonia. The present study aimed to determine the risk factors for POP in EC. Patients and Methods The subjects of this retrospective study were 151 patients with EC who underwent subtotal esophagectomy in our department between January 2012 and December 2021. Univariate and multivariate logistic regression analyses were used to evaluate the association between the incidence of POP and clinical factors. Result Among 151 patients, 33 cases (21.8%) developed POP. Multivariate analysis identified preoperative C-reactive protein-to-albumin ratio (CAR) ≥0.03 (odds ratio (OR): 2.69, P=0.0352), chronic obstructive lung disease (COPD) (OR: 7.32, P=0.0001), and diabetes mellitus (DM) (OR: 3.35, P=0.0252) as independent risk factors for POP. In accordance with the number of risk factors, the incidence rate of POP drastically increased, and its rate in patients with three risk factors was 80%. Conclusion High CAR, COPD, and DM are independent risk factors for the development of POP in patients undergoing subtotal esophagectomy for EC. Clinicians should be aware of the risk factors for POP and consider more intensive preventive measures and postoperative management in patients with EC.

Effect of lung isolation with different airway devices on postoperative pneumonia in patients undergoing video-assisted thoracoscopic surgery: a propensity score-matched study

BackgroundPostoperative pneumonia is one of the common complications after video-assisted thoracoscopic surgery. There is no related study on the effect of lung isolation with different airway devices on postoperative pneumonia. Therefore, in this study, the propensity score matching method was used to retrospectively explore the effects of different lung isolation methods on postoperative pneumonia in patients undergoing video-assisted thoracoscopic surgery.MethodsThis is A single-center, retrospective, propensity score-matched study. The information of patients who underwent VATS in Weifang People 's Hospital from January 2020 to January 2021 was retrospectively included. The patients were divided into three groups according to the airway device used in thoracoscopic surgery: laryngeal mask combined with bronchial blocker group (LM + BB group), tracheal tube combined with bronchial blocker group (TT + BB group) and double-lumen endobronchial tube group (DLT group). The main outcome was the incidence of pneumonia within 7 days after surgery; the secondary outcome were hospitalization time and hospitalization expenses. Patients in the three groups were matched using propensity score matching (PSM) analysis.ResultsAfter propensity score matching analysis, there was no significant difference in the incidence of postoperative pneumonia and hospitalization time among the three groups (P > 0.05), but there was significant difference in hospitalization expenses among the three groups (P < 0.05).ConclusionsThere was no significant difference in the effect of different intubation lung isolation methods on postoperative pneumonia in patients undergoing thoracoscopic surgery.

Non-linear relationship between preoperative albumin-globulin ratio and postoperative pneumonia in patients with hip fracture

Background and objectivePostoperative pneumonia (POP) is the leading cause of death among patients with hip fractures. Simple and cost-effective markers can be used to assess the risk of these patients. This study aims to investigate the association between POP and preoperative albumin-globulin ratio (AGR) in patients with hip fractures. MethodsA retrospective analysis was conducted on data from 1417 hip fracture patients admitted to the Department of Orthopaedics at the hospital. Generalized additive and logistic regression models were used to determine both linear and non-linear associations between preoperative AGR and POP. A two-piece regression model was employed to determine the threshold effect. ResultsThe study included 1417 participants, with a mean age of 77.57 (8.53) years and 26.96% (382/1417) male patients. The prevalence of POP was 6.21%. Following full covariate adjustment, each unit increase in AGR was associated with a 79% reduction in the incidence of POP (OR, 0.23; 95% CI: 0.08–0.63; P = 0.0046). The inflection point was found to be 1.33 using a two-piecewise regression model. For each unit increase in AGR on the left side of the inflection point, the incidence of POP decreased by 93% (OR, 0.07; 95%CI: 0.02–0.34; P = 0.0010). However, there was no statistically significant correlation on the right side of the inflection point (OR, 0.84; 95% CI: 0.17–4.10; P = 0.8287). ConclusionThere exists a non-linear association between preoperative AGR and the incidence of POP in elderly hip fracture patients. When AGR is less than 1.33, the incidence of POP is negatively correlated with AGR. However, there is no correlation when AGR is greater than 1.33.

RISK FACTORS FOR THE DEVELOPMENT OF NOSOCOMIAL PNEUMONIA AFTER AORTIC ARCH SURGERY

HighlightsFor the first time, the incidence and timing of the development of postoperative pneumonia in patients undergoing surgical reconstruction of the aortic arch in the post-covid period were studied. Risk factors for pneumonia and predictors of the severe course of the disease in this cohort of patients were identified. The results obtained will make it possible to differentiate patients at risk of developing pneumonia from the general population of patients undergoing surgical reconstruction of the aortic arch for targeted perioperative prevention of this complication. AbstractAim. To study the incidence of nosocomial pneumonia (NP) after aortic arch surgery, and to determine the impact of perioperative factors on the risk for its development and severity of its course.Methods. A retrospective analysis of 66 case histories of patients who underwent aortic arch surgery in 2022 was carried out. The incidence and timing of the development of pneumonia were revealed, the severity of its course was assessed. The impact of the main demographic, clinical, perioperative factors on the risk for the pneumonia development and the severity of its course was studied.Results. The incidence of pneumonia after aortic arch surgery was 24.2%. A relationship between smoking (OR 1.17; 95% CI [0.23; 1.43], p = 0.007), smoking index (OR 0.99; 95% CI [0.92; 1.07], p = 0.002) and the risk of NP developing as well as between the duration of mechanical ventilation and the severity of NP was found with a univariate logistic regression analysis (OR 1.26; 95% CI [1.0; 1.59], p = 0.049).Conclusion. The risk for NP development in patients who underwent thoracic aortic surgery is associated with smoking and smoking intensity in the preoperative period. The predictor of the severe course of NP is the duration of mechanical ventilation.

Risk Factors of Postoperative Hospital-Acquired Pneumonia in Patients Undergoing Cardiac Surgery.

Background and Objectives. Hospital-acquired pneumonia is one of the complications that may occur in the postoperative period in patients undergoing heart valve surgery, which may result in prolonged hospitalization, development of respiratory failure requiring mechanical ventilation or even death. This study investigated the preoperative risk factors of postoperative pneumonia after heart valve surgery. Materials and Methods: This was a prospective study in a group of consecutive patients with hemodynamically significant valvular heart disease undergoing valve surgery. The primary endpoint at the in-hospital follow-up was hospital-acquired pneumonia after heart valve surgery. Logistic regression analysis was used to assess which variables were predictive of the primary endpoint, and odds ratios (ORdis) were calculated with a 95% confidence interval (CI). Multivariate analysis was based on the results of single-factor logistic regression, i.e., in further steps all statistically significant variables were taken into consideration. Results: The present study included 505 patients. Postoperative pneumonia occurred in 23 patients. The mean time to diagnosis of pneumonia was approximately 3 days after heart valve surgery (±2 days). In multivariate analysis, preoperative level of high-sensitivity Troponin T (hs-TnT) (OR 2.086; 95% CI 1.211-3.593; p = 0.008) and right ventricular systolic pressure (RVSP) (OR 1.043; 95% CI 1.018-1.067; p 0.004) remained independent predictors of the postoperative pneumonia. Of the patients with postoperative pneumonia, 3 patients died due to the development of multiple organ dysfunction syndrome (MODS). Conclusions: Preoperative determination of serum hs-TnT concentration and echocardiographic measurement of the RVSP parameter may be useful in predicting postoperative pneumonia in patients undergoing heart valve surgery.

Longitudinal Analysis of Dysphagia and Factors Related to Postoperative Pneumonia in Patients Undergoing Esophagectomy for Esophageal Cancer

AbstractFew studies have quantified longitudinal changes in swallowing in patients undergoing esophagectomy for esophageal cancer. This study longitudinally analyzed the changes in the Modified Barium Swallow Study Impairment Profile (MBSImP™) scores, swallowing kinematic measurements, and swallowing-related symptoms in patients undergoing esophagectomy. We also examined the association between identified swallowing impairment and aspiration pneumonia after surgery. We included consecutive patients who underwent esophagectomy and completed laryngoscopy and videofluoroscopy before, two weeks, and three months after surgery. We analyzed physiological impairments using the MBSImP. We also assessed the swallowing kinematics on a 5 mL thickened liquid bolus at three time points. Vocal fold mobility was assessed using a laryngoscope. Repeated measures were statistically examined for longitudinal changes in swallowing function. The association between the significant changes identified after esophagectomy and aspiration pneumonia was tested. Twenty-nine patients were included in this study. Preoperative swallowing function was intact in all participants. The timing of swallowing initiation and opening of the pharyngoesophageal segment remained unchanged after surgery. Tongue base retraction and pharyngeal constriction ratio worsened two weeks after surgery but returned to baseline levels three months after surgery. Three months after surgery, hyoid displacement and vocal fold immobility did not fully recover. Aspiration pneumonia occurred in nine patients after surgery and was associated with postoperative MBSImP pharyngeal residue scores. Decreased hyoid displacement and vocal fold immobility were observed postoperatively and persisted for a long time. The postoperative pharyngeal residue was associated with pneumonia and thus should be appropriately managed after surgery.

Seven preoperative factors have strong predictive value for postoperative pneumonia in patients undergoing thoracoscopic lung cancer surgery

Seven preoperative factors have strong predictive value for postoperative pneumonia in patients undergoing thoracoscopic lung cancer surgery

Risk factors for postoperative pneumonia in patients undergoing resection for non-small cell lung cancer

Risk factors for postoperative pneumonia in patients undergoing resection for non-small cell lung cancer

Development and external validation of a nomogram for predicting postoperative pneumonia in aneurysmal subarachnoid hemorrhage.

Postoperative pneumonia (POP) is a common complication after aneurysmal subarachnoid hemorrhage (aSAH) associated with increased mortality rates, prolonged hospitalization, and high medical costs. It is currently understood that identifying pneumonia early and implementing aggressive treatment can significantly improve patients' outcomes. The primary objective of this study was to explore risk factors and develop a logistic regression model that assesses the risks of POP. An internal cohort of 613 inpatients with aSAH who underwent surgery at the Neurosurgical Department of First Affiliated Hospital of Wenzhou Medical University was retrospectively analyzed to develop a nomogram for predicting POP. We assessed the discriminative power, accuracy, and clinical validity of the predictions by using the area under the receiver operating characteristic curve (AUC), the calibration curve, and decision curve analysis (DCA). The final model was validated using an external validation set of 97 samples from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Among patients in our internal cohort, 15.66% (n = 96/613) of patients had POP. The least absolute shrinkage and selection operator (LASSO) regression analysis identified the Glasgow Coma Scale (GCS), mechanical ventilation time (MVT), albumin, C-reactive protein (CRP), smoking, and delayed cerebral ischemia (DCI) as potential predictors of POP. We then used multivariable logistic regression analysis to evaluate the effects of these predictors and create a final model. Eighty percentage of patients in the internal cohort were randomly assigned to the training set for model development, while the remaining 20% of patients were allocated to the internal validation set. The AUC values for the training, internal, and external validation sets were 0.914, 0.856, and 0.851, and the corresponding Brier scores were 0.084, 0.098, and 0.143, respectively. We found that GCS, MVT, albumin, CRP, smoking, and DCI are independent predictors for the development of POP in patients with aSAH. Overall, our nomogram represents a reliable and convenient approach to predict POP in the patient population.

Association of hemoglobin levels at admission with postoperative pneumonia in elderly patients with hip fracture: A retrospective cohort study.

Previous studies have suggested a correlation between low preoperative hemoglobin (Hb) levels and postoperative pneumonia (POP) in elderly patients with hip fractures. However, the exact inflection point of Hb level that increases the risk of POP remains unclear. This study aimed to investigate the quantitative relationship between preoperative Hb levels and the incidence of POP in this patient population. This retrospective study included 1417 elderly patients with hip fractures who were admitted to the Department of Orthopedics at Shenzhen Second People's Hospital between January 2012 and December 2021. Demographic and clinical data, including laboratory test results, were analyzed and compared to explore the relationship between Hb levels at admission and the incidence of POP in this patient population. This study included 1417 elderly patients with hip fractures, comprising 382 males and 1035 females, with a mean age of 77.57 ± 8.73 years. The incidence of POP was 6.21% (88/1417) in this patient population. After adjusting for confounding factors in model II, the regression equation showed that the incidence of POP decreased by 2% with each 1 g/L increment in Hb levels (OR: 0.98, 95% CI: 0.97-1.00; P = .0211). Additionally, a two-piecewise regression model was used to explore the relationship between Hb levels and POP incidence, after adjusting for confounding factors. Threshold effect analysis showed that the inflection point was 83.5 g/L. On the left side of the inflection point, Hb levels were negatively correlated with the incidence of POP (OR: 0.91, 95% CI: 0.86-0.97, P = .0030). There was a nonlinear relationship between preoperative Hb level and POP in elderly patients with hip fractures. When Hb levels were lower than 83.5 g/L, preoperative Hb levels were negatively correlated with POP.

The Evaluation of Sarcopenia before Neoadjuvant Chemotherapy Is Important for Predicting Postoperative Pneumonia in Patients with Esophageal Cancer

Introduction: Sarcopenia is often observed in patients with esophageal cancer (EC). However, the influence of sarcopenia during neoadjuvant chemotherapy (NAC) on complications has not been fully investigated. Thus, we aimed to investigate the best way of evaluating sarcopenia for predicting complications, especially postoperative pneumonia (PP), in patients with EC undergoing NAC and esophagectomy. Methods: We retrospectively reviewed 113 patients. The skeletal muscle mass index (SMI) was evaluated by bioelectrical impedance analysis and/or computed tomography. Patients were diagnosed with sarcopenia at pre-NAC and preoperative timing. Different criteria were compared in terms of the predictability of PP. Next, we evaluated which factors were related to sarcopenia with the best PP predictability. Results: Fifteen (13.2%) patients developed grade III or higher PP. Pre-NAC modified European Working Group on Sarcopenia in Older People (EWGSOP) criteria showed the highest sensitivity (100%) and acceptable specificity (75.8%) for predicting PP. Low pre-NAC body mass index and %VC were significantly associated with sarcopenia by the modified EWGSOP criteria. Conclusion: Pre-NAC sarcopenia by modified EWGSOP was a significant predictor of PP after esophagectomy. Appropriate interventions for these patients should be explored to prevent PP.

Nomogram prediction model of postoperative pneumonia in patients with lung cancer: A retrospective cohort study.

The prediction model of postoperative pneumonia (POP) after lung cancer surgery is still scarce. Retrospective analysis of patients with lung cancer who underwent surgery at The Fourth Hospital of Hebei Medical University from September 2019 to March 2020 was performed. All patients were randomly divided into two groups, training cohort and validation cohort at the ratio of 7:3. The nomogram was formulated based on the results of multivariable logistic regression analysis and clinically important factors associated with POP. Concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow goodness-of-fit test and decision curve analysis (DCA) were used to evaluate the predictive performance of the nomogram. A total of 1252 patients with lung cancer was enrolled, including 877 cases in the training cohort and 375 cases in the validation cohort. POP was found in 201 of 877 patients (22.9%) and 89 of 375 patients (23.7%) in the training and validation cohorts, respectively. The model consisted of six variables, including smoking, diabetes mellitus, history of preoperative chemotherapy, thoracotomy, ASA grade and surgery time. The C-index from AUC was 0.717 (95%CI:0.677-0.758) in the training cohort and 0.726 (95%CI:0.661-0.790) in the validation cohort. The calibration curves showed the model had good agreement. The result of DCA showed that the model had good clinical benefits. This proposed nomogram could predict the risk of POP in patients with lung cancer surgery in advance, which can help clinician make reasonable preventive and treatment measures.

Muscular tissue desaturation and pneumonia in patients receiving lung cancer surgery: a cohort study.

Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery. This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO2) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO2 was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO2 of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO2 in the forearm and that in the thigh. We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO2 < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center. Muscular tissue desaturation, defined as a baseline SmtO2 < 80% in the forearm, may be associated with an increased risk of POP. No. ChiCTR-ROC-17012627.

The Influence of Preoperative Smoking Status on Postoperative Complications and Long-Term Outcome Following Thoracoscopic Esophagectomy in Prone Position for Esophageal Carcinoma.

Esophagectomy for esophageal carcinoma is associated with higher morbidity and mortality rates than other gastrointestinal surgeries. Smoking is an established risk factor for postoperative complications after esophagectomy. This study aimed retrospectively to investigate the impact of smoking status on short- and long-term outcomes for patients undergoing thoracoscopic esophagectomy in the prone position (TEP) for esophageal carcinoma. In this study, 234 patients with esophageal carcinoma who underwent TEP between 2012 and 2020 were divided into two groups based on smoking status (current or non-current smokers and the Brinkman index) by patients' declarations. Postoperative complications (Clavien-Dindo classification grade ≥2), overall survival (OS), and disease-free survival (DFS) were compared between smoking statuses. The rates of postoperative complications did not differ significantly between the two groups (current smoker vs non-current smoker; Brinkman index ≥800 vs <800). The rate of postoperative pneumonia was higher in the combination group of current and higher Brinkman index (≥800) smokers than in the other group (25.0 % vs 11.8 %; P = 0.036). Multivariate analysis showed that smoking status was an independent risk factor for postoperative pneumonia (hazard ratio, 0.41; 95 % confidence interval, 0.18-0.93; P = 0.037). According to the long-term outcomes, no significant differences in OS and DFS were observed between the smoking statuses. The combination of current smoking and heavy smoking history is a risk factor for postoperative pneumonia in patients who have esophageal carcinoma treated with TEP, although no correlation was observed between the long-term outcomes and smoking status.

Effects of Perioperative Oral Management in Patients with Cancer.

Perioperative oral management (POM) is used to prevent pneumonia in patients with cancer. However, the factors that expose hospitalized patients to increased risk of developing pneumonia remain unclear. For example, no study to date has compared the incidence of pneumonia in hospitalized patients by cancer primary lesion, or POM implementation, or not. We determined which patients were most likely to benefit from POM and examined the effects of POM on pneumonia prevention and mortality. In a total of 9441 patients with cancer who underwent surgery during hospitalization, there were 8208 patients in the No POM group, and 1233 in the POM group. We examined between-group differences in the incidence of pneumonia and associated outcomes during hospitalization. There was no significant between-group difference in the incidence of pneumonitis, however, patients with lung, or head and neck cancers, demonstrated a lower incidence of postoperative pneumonia. Among patients with lung and pancreatic cancers, mortality was significantly lower in the POM group. POM appears effective at reducing the risk of postoperative pneumonia in patients with certain cancers. Further, mortality was significantly lower in patients with lung and pancreatic cancers who received POM; hence, POM may be an effective adjuvant therapy for patients with cancer.

Association between masseter muscle sarcopenia and postoperative pneumonia in patients with esophageal cancer

Sarcopenia affects the swallowing and chewing muscles, such as the masseter muscle. However, the significance of masseter muscle loss in pneumonia remains unclear. We investigated the effects of masseter muscle sarcopenia (MMS) on postoperative pneumonia in patients with esophageal cancer. In this retrospective cohort study, we analyzed the data of 86 patients who underwent esophagectomy for stage I–III esophageal cancer at our hospital between March 2013 and October 2021. The primary endpoint was postoperative pneumonia within 3 months of surgery. MMS was defined as a (1) masseter muscle index (MMI) that was less than the sex-specific MMI cutoff values, and (2) sarcopenia diagnosed using the L3-psoas muscle index (L3-PMI). Postoperative pneumonia was noted in 27 (31.3%) patients. In multivariate analysis, FEV1.0 < 1.5 L (odds ratio, OR: 10.3; 95% confidence interval, CI 1.56–67.4; p = 0.015), RLNP (OR: 5.14; 95%CI 1.47–17.9; p = 0.010), and MMS (OR: 4.83; 95%CI 1.48–15.8; p = 0.009) were independent risk factors for postoperative pneumonia. The overall survival was significantly worse in patients with pneumonia (log-rank: p = 0.01) than in those without pneumonia. Preoperative MMS may serve as a predictor of postoperative pneumonia in patients with esophageal cancer.

High platelet distribution width is an independent risk factor of postoperative pneumonia in patients with type A acute aortic dissection.

BackgroundPlatelet distribution width (PDW), as a widely applied and reliable marker of platelet activation, was associated with adverse outcomes in cardiovascular diseases. However, there is little literature on the relationship between PDW and postoperative pneumonia in patients with type A acute aortic dissection (AAAD).MethodsIn this retrospective cohort study, we collected consecutive patients who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University from January 1, 2014 and June 30, 2020. Patients were divided into three tertiles on the basis of the PDW. The independent effect of the PDW on postoperative pneumonia was evaluated using multivariate logistic regression analysis, and smooth curve fitting was performed to visualize the linear relationship between PDW and the risk of postoperative pneumonia in patients with AAAD.ResultsA total of 210 patients with AAAD were enrolled and the overall incidence of postoperative pneumonia was 25.24% (n = 53). Multivariate logistic regression revealed that PDW was positively associated with the risk of postoperative pneumonia (OR: 1.07, 95% CI: 1.02–1.13, P < 0.05) after adjusting the confounders. Compared with the lowest PDW tertile, the risk of postoperative pneumonia increased by 1.21-fold in the medium PDW tertile (OR: 2.21, 95% CI: 0.73–6.72) and by 3.16-fold in the highest PDW tertile (OR: 4.16, 95% CI: 1.40–12.33). A straight-line relationship was observed between PDW and postoperative pneumonia risk in smoothing spline fitting.ConclusionOur findings indicate that high PDW is an independent risk factor of postoperative pneumonia in patients with AAAD. Preoperative PDW may serve as an available indicator of pneumonia, which helps identify AAAD patients with a high risk of postoperative pneumonia.

Determination of risk factors of postoperative pneumonia in elderly patients with hip fracture: What can we do?

BackgroundPostoperative pneumonia is a serious complication in elderly patients with hip fracture. It is necessary to identify the influencing factors of postoperative pneumonia in patients with hip fracture.MethodsElderly patients with hip fractures admitted to a tertiary hospital in China from January 1, 2020 to August 31, 2021 were included. The characteristics of patients with and without postoperative pneumonia were evaluated and compared. Logistic multivariate regression analyses were conducted to assess the risk factors of postoperative pneumonia.Results267 patients with hip fracture were included, the incidence of postoperative pneumonia in patients with hip fracture was 13.11%. There were significant differences in the age, diabetes mellitus, anemia, hypoalbuminemia, anesthesia method and duration of surgery between infection and no infection group, no significant differences in the gender, BMI, hypertension, hyperlipidemia, type of fracture, preoperative oxygen saturation, white blood cell count, platelet count, red blood cell count, creatinine, alanine aminotransferase, aspartate aminotransferase, estimated blood loss during surgery were detected between infection and no infection group. Logistic regression analysis showed that age≥70y (OR2.326, 95%CI1.248~3.129), diabetes mellitus (OR2.123, 95%CI1.021~3.551), anemia (OR3.199,95%CI1.943~5.024), hypoalbuminemia (OR2.377, 95%CI1.211~3.398), general anesthesia (OR1.947, 95%CI1.115~3.038), duration of surgery≥120min (OR1.621, 95%CI1.488~2.534) were the risk factors of postoperative pneumonia in elderly patients with hip fracture (all p<0.05). Escherichia Coli (33.33%), Klebsiella pneumoniae (28.57%), Staphylococcus aureus (21.43%) were the most common bacteria of pulmonary infection.ConclusionThere are many risk factors for postoperative pneumonia in elderly patients with hip fractures after surgery. In clinical practice, medical workers should take targeted interventions for those risk factors to reduce postoperative pneumonia.