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

Zhuo, Haoran; Yang, Guang; Huang, Huang; Li, Chunmei; Wang, Xiaoxiong; Moliterno, Jennifer; Zhang, Yawei

doi:10.1016/j.jhin.2020.03.015

Cited by 24 publications

(22 citation statements)

References 23 publications

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“…Our result showed that pneumonia was more frequently incident in patients with hypoalbuminemia than in patients without hypoalbuminemia. Increasing age, extending operative time as risk factors for postoperative pneumonia were consistent with previous studies [15][16][17] . Postoperative albumin as a novel factors warrant further investigation.…”

Section: Discussionsupporting

confidence: 90%

“…Postoperative pulmonary complications were signi cantly associated with poor outcome, including higher reoperation, readmission, mortality, and extended hospital stay in patients that surgical resection of brain tumors 15,16 . Previous study identi ed increasing operative time, increasing age, and increasing estimated blood loss, diabetes, chronic obstructive pulmonary disease, preoperative leukocytosis, American Society of Anesthesiologists classi cation ≥ 3, and infratentorial lesions as risk factors for postoperative pneumonia in postcraniotomy patients [15][16][17] . However, in infratentorial craniotomy with high risk for the development of postoperative pulmonary complications, the predictors for the occurrence of postoperative pulmonary complications were postoperative blood transfusion, lower cranial nerve palsy, prolonged ICU stay and tracheostomy 18 .…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy

Zhao

Zhang

Wei

et al. 2021

Preprint

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Hypoalbuminemia is associatied with poor outcome in patients undergoing surgery intervention. The main aim for this study was to investigate the incidence and the risk factors of postoperative hypoalbuminemia and assessed the impact of postoperative hypoalbuminemia on complications in patients undergoing brain tumor surgery. This retrospective study included 372 consecutive patients who underwent brain tumors surgery from January 2017 to December 2019. The patients were divided into hypoalbuminemia (< 35 g/L) and non-hypoalbuminemia group (≥ 35 g/L) based on postoperative albumin levels. Logistic regression analyses were used to determine risk factors. Of the total 372 patients, 333 (89.5%) developed hypoalbuminemia after surgery. Hypoalbuminemia was associated with operation time (OR 1.011, P < 0.001), preoperative albumin (OR 0.864, P = 0.015) and peroperative globulin (OR 1.192, P = 0.004). Postoperative pneumonia had a higher incidence in patients with than without hypoalbuminemia (41.1% vs 23.1%, P = 0.029). The independent predictors of postoperative pneumonia were age (OR 1.053, P < 0.001), operation time (OR 1.003, P = 0.013) and lower postoperative albumin (OR 0.946, P = 0.018). Postoperative hypoalbuminemia has a higher incidence with the increase of operation time, and is associated with postoperative pneumonia in patients undergoing brain tumor surgery.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy

Zhao

Zhang

Wei

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…For many malignancies, the better predictive abilities of nomograms than the widely adopted tumor-node-metastasis (TNM) staging system have been demonstrated (10,13). Recently, some studies have also explored the clinical applicability of nomograms for predicting short-term outcomes, including in-hospital mortality, postoperative pneumonia, perioperative complications, etc., which could help surgeons and nurses make appropriate clinical decisions and formulate postoperative management strategies for patients (11,14,15). However, to date, a nomogram for precisely forecasting operative mortality in patients who underwent pneumonectomy remains unavailable.…”

Section: Introductionmentioning

confidence: 99%

Development of a nomogram for predicting the operative mortality of patients who underwent pneumonectomy for lung cancer: a population-based analysis

Gao

Qin

et al. 2021

Transl Lung Cancer Res

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Background: Although many studies have reported that patients have undergone entire lung removal for lung cancer along with high operative mortality, the trends in the incidence and associated risk factors for operative death have not been explored in a national population-based study. In addition, a clinical decisionmaking nomogram for predicting postpneumonectomy mortality remains lacking.Methods: A total of 10,337 patients diagnosed with lung cancer who underwent pneumonectomy between 1998 and 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) cancer registry.Multivariate logistic regression analysis was used to identify risk factors for predicting operative mortality.Thereafter, these independent predictors were integrated into a nomogram, and bootstrap validation was applied to assess the discrimination and calibration. Additionally, decision curve analysis (DCA) was used to calculate the net benefit of this forecast model. Results:The overall postpneumonectomy mortality between 1998 and 2016 was 10.3%, including a 30-day mortality of 4.2%; however, there were statistically significant decreases in the operative death rates from 8.8% in 1998 to 6.7% in 2016 (P=0.009). Higher operative mortality was associated with advanced patients (P<0.001), male sex (P<0.001), right-sided pneumonectomy (P<0.001), squamous cell carcinoma (SCC) (P=0.008), number of positive lymph nodes (npLNs) 5 or greater (P=0.010), and distant metastasis (P<0.001).However, induction radiotherapy (RT) was a protective factor (P<0.001). The nomogram integrating all of the above independent predictors was well calibrated and had a relatively good discriminative ability, with a C-statistic of 0.687 and an area under the receiver operating characteristic (ROC) curve (AUC) of 0.682; moreover, DCA demonstrated that our model was clinically useful.Conclusions: If pneumonectomy was considered inevitable, clinical decision-making based on this simple but efficient predictive nomogram could help minimize the risk of operative death and maximize the survival benefit.

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“…Lee et al [23] suggested that gamma knife treatment before microdissection may increase the probability of postoperative complications, which is in line with our results. We found that the incidence of postoperative pulmonary infection in group A was higher than that in group B, which may be due to the following: 1) prolonged operation time tends to increase the probability of pulmonary infection after craniocerebral surgery [40]. A previous study has reported that the average operation time of vestibular schwannoma patients with gamma knife treatment history takes 95 minutes longer [24].…”

Section: Discussionmentioning

confidence: 80%

Effectiveness and Safety Evaluation of Microresection of Vestibular Schwannoma After Gamma Knife Treatment

Huang

Ren

Liu

et al. 2021

Preprint

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PURPOSEWe aimed to explored the influence of preoperative gamma knife treatment on the clinical effect of microsurgical resection of vestibular schwannoma.METHODSThe patients who underwent vestibular schwannoma resection in our hospital between November 2010 and December 2019 were retrospectively collected. According to retrospectively collected data, the patients who met the inclusion and exclusion criteria were defined as group A. The 1:3 ratio design was adopted in this study to select the group B that was not subjected to gamma knife treatment in the same period. The pre/postoperative clinical manifestations, neurological function grade, postoperative complications, tumor recurrence and increase were collected and compared between the two groups.RESULTSThere were 40 patients in group A and 120 patients in group B. At the last follow-up, the number of patients with poor facial nerve function was 15 (39.5%) in group A and 25 (21.2%) in group B (P = 0.025). In group A and group B, disequilibrium occurred in 14 patients and 17 patients respectively after operation (P=0.003). 7 patients caught the pulmonary infection in group A and 3 patients had a pulmonary infection in group B (P=0.03) after operation. CONCLUSIONSwhen a patient with vestibular schwannoma undergoes microsurgical surgery, the preoperative history of gamma knife treatment will make a recovery from postoperative facial paralysis difficult for the patients, making them more prone to suffer from postoperative disequilibrium and postoperative pulmonary infection.

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

Cited by 24 publications

References 23 publications

Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy

Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy

Development of a nomogram for predicting the operative mortality of patients who underwent pneumonectomy for lung cancer: a population-based analysis

Effectiveness and Safety Evaluation of Microresection of Vestibular Schwannoma After Gamma Knife Treatment

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