The Risk Factors and Prediction Model for Postoperative Pneumonia After Craniotomy

Overview

Journal Front Cell Infect Microbiol

Date 2025 Jan 8

PMID 39776439

Authors

Bingbing Xiang

Mingliang Yi

Chunyan Li

Hong Yin

Shun Wang

Yiran Liu

Affiliations

Soon will be listed here.

Abstract

Background: Craniotomy is highly susceptible to postoperative pneumonia, which significantly impacts the outcomes of patients undergoing such procedures. Our study aims to examine the risk factors associated with postoperative pneumonia and establish a predictive model with a nomogram to assess this risk.

Methods: We conducted a matched 1:1 case-control study involving 831 adult patients undergoing craniotomy at our hospital. Cases consisted of patients who developed postoperative pneumonia within 30 days after surgery, as defined by consensus criteria. Controls were randomly selected from a pool of eligible patients.

Results: The overall incidence rate of postoperative pneumonia is 12.39% in a total of 831 surgeries, which associated with unfavorable outcomes. Gram-negative bacteria were found to be the most common causative agents and approximately 27.94% of cases attributed to multi-drug resistant strains. The logistic regression analysis revealed five independent risk factors, as follows: smoking history, surgical duration, postoperative albumin, unplanned re-operation, and deep vein catheterization. A risk prediction model was derived and a nomogram was constructed. The Hosmer-Lemeshow test yielded X = 3.871 (P=0.869), and the receiver operator characteristic curve analysis demonstrated an area under the curve of 0.898 (P<0.05), with a sensitivity of 79.6% and a specificity of 85.4%, indicating excellent model fit and predictive performance. In addition, the C-index of the nomogram model was 0.898(95%CI, 0.853~0.941). The calibration curves of the nomogram model showed p-values of 0.797 and the Brier scores were 0.127. The analysis of the clinical decision curve showed that the nomograph model had high clinical application value.

Conclusions: Postoperative pneumonia patients after craniotomy exhibits distinct pathogen distribution and is strongly associated with unfavorable outcomes. The risk prediction model developed in this study demonstrates a good fitting degree and predictive performance. The constructed nomogram model is objective, specific, and easily applicable in clinical practice.

References

Xiang B, Jiao S, Si Y, Yao Y, Yuan F, Chen R . Risk Factors for Postoperative Pneumonia: A Case-Control Study. Front Public Health. 2022; 10:913897. PMC: 9304902. DOI: 10.3389/fpubh.2022.913897. View

Fan Chiang Y, Lee Y, Lam F, Liao C, Chang C, Lin C . Smoking increases the risk of postoperative wound complications: A propensity score-matched cohort study. Int Wound J. 2022; 20(2):391-402. PMC: 9885463. DOI: 10.1111/iwj.13887. View

Dewan M, Rattani A, Gupta S, Baticulon R, Hung Y, Punchak M . Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018; 130(4):1080-1097. DOI: 10.3171/2017.10.JNS17352. View

Lim S, Ong K, Chan Y, Loke W, Ferguson M, Daniels L . Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2011; 31(3):345-50. DOI: 10.1016/j.clnu.2011.11.001. View

Abbott T, Fowler A, Pelosi P, Gama de Abreu M, Moller A, Canet J . A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. Br J Anaesth. 2018; 120(5):1066-1079. DOI: 10.1016/j.bja.2018.02.007. View

Zhao J, Song J, Yuan Q, Bao Y, Sun Y, Li Z . Characteristics and therapeutic profile of TBI patients who underwent bilateral decompressive craniectomy: experience with 151 cases. Scand J Trauma Resusc Emerg Med. 2022; 30(1):59. PMC: 9670501. DOI: 10.1186/s13049-022-01046-w. View

McCoy C, Englum B, Keenan J, Vaslef S, Shapiro M, Scarborough J . Impact of specific postoperative complications on the outcomes of emergency general surgery patients. J Trauma Acute Care Surg. 2015; 78(5):912-8. DOI: 10.1097/TA.0000000000000611. View

Wang L, Cao X, Shi L, Ma Z, Wang Y, Liu Y . Risk factors for intracranial infection after craniotomy: A case-control study. Brain Behav. 2020; 10(7):e01658. PMC: 7375057. DOI: 10.1002/brb3.1658. View

Longo M, Feigen C, De La Garza Ramos R, Gelfand Y, Echt M, Agarwal V . Predictors of reoperation and noninfectious complications following craniotomy for cerebral abscess. Clin Neurol Neurosurg. 2019; 179:55-59. DOI: 10.1016/j.clineuro.2019.02.020. View

10.

Li F, Yuan M, Wang L, Wang X, Liu G . Characteristics and prognosis of pulmonary infection in patients with neurologic disease and hypoproteinemia. Expert Rev Anti Infect Ther. 2015; 13(4):521-6. DOI: 10.1586/14787210.2015.1019471. View

11.

Teichgraber U, Kausche S, Nagel S, Gebauer B . Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol. 2011; 21(6):1224-32. DOI: 10.1007/s00330-010-2045-7. View

12.

Zhang X, Zhou H, Shen H, Wang M . Pulmonary infection in traumatic brain injury patients undergoing tracheostomy: predicators and nursing care. BMC Pulm Med. 2022; 22(1):130. PMC: 8988413. DOI: 10.1186/s12890-022-01928-w. View

13.

Yao J, Liu D . Logistic Regression Analysis of Risk Factors for Intracranial Infection After Multiple Traumatic Craniotomy and Preventive Measures. J Craniofac Surg. 2019; 30(7):1946-1948. DOI: 10.1097/SCS.0000000000004972. View

14.

Wei L, Champman S, Li X, Li X, Li S, Chen R . Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China. BMJ Open. 2017; 7(10):e017293. PMC: 5640055. DOI: 10.1136/bmjopen-2017-017293. View

15.

Viasus D, Garcia-Vidal C, Simonetti A, Manresa F, Dorca J, Gudiol F . Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia. J Infect. 2013; 66(5):415-23. DOI: 10.1016/j.jinf.2012.12.007. View

16.

Lo Y, See A, King N . Decompressive Craniectomy in Spontaneous Intracerebral Hemorrhage: A Case-Control Study. World Neurosurg. 2017; 103:815-820.e2. DOI: 10.1016/j.wneu.2017.04.025. View

17.

Pujari R, Hutchinson P, Kolias A . Surgical management of traumatic brain injury. J Neurosurg Sci. 2018; 62(5):584-592. DOI: 10.23736/S0390-5616.18.04533-2. View

18.

Renz N, Ozdirik B, Finger T, Vajkoczy P, Trampuz A . Infections After Cranial Neurosurgery: Prospective Cohort of 103 Episodes Treated According to a Standardized Algorithm. World Neurosurg. 2018; 116:e491-e499. DOI: 10.1016/j.wneu.2018.05.017. View

19.

Fu S, Hou P, Wang G, Wang S . Causes and risk factors of an unplanned second craniotomy in patients with traumatic brain injury. BMC Surg. 2023; 23(1):78. PMC: 10074669. DOI: 10.1186/s12893-023-01977-w. View

20.

Michalopoulos A, Kasiakou S, Mastora Z, Rellos K, Kapaskelis A, Falagas M . Aerosolized colistin for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria in patients without cystic fibrosis. Crit Care. 2005; 9(1):R53-9. PMC: 1065114. DOI: 10.1186/cc3020. View