Risk factors for postoperative pneumonia after hepatectomy with extrahepatic bile duct resection

Abstract

Background The present study investigated the incidence of postoperative pneumonia (POP) after hepatectomy with extrahepatic bile duct resection (BDR) and elucidated risk factors for POP. Methods A total of 257 patients undergoing hepatectomy with BDR between 2011 and 2019 were retrospectively reviewed to evaluate the incidence of POP, defined by the Clavien‐Dindo grade ≥ II. The predictive factors for POP were identified using logistic regression analysis of the pre‐ and intraoperative evaluable factors. Results Postoperative pneumonia developed in 15 patients (5.8%), diagnosed as grade IV or V in five patients. In a multivariate analysis, a vital capacity ratio (%VC) <80% (odds ratio [OR] 7.30, P = .005), age ≥ 74 years old (OR 5.39, P = .026), and future liver volume remnant (FLR) ratio ≤ 40% (OR 4.97, P = .045) were independent risk factors for POP. Among patients with performing spirometry, the incidence of developing POP was 1.0%, 8.8%, and 60% in patients with 0, 1‐2, and 3 risk factors, respectively. Conclusions The incidence of POP in patients undergoing hepatectomy with BDR was 5.8%. A %VC <80%, age ≥74 years old, and FLR ratio ≤40% were identified as preoperative predictive factors of developing POP.