The Risk Factors Analysis Of Non-Cardiothoracic Surgery Patients With Postoperative Pneumonia And Prognosis

Objective By the retrospective analysis of non-cardiothoracic surgery patients,discussing the effect of factors related to the different underlying diseases, operation, anesthesia on patients with postoperative pneumonia and prognosis. And providing a reliable basis for the prevention and treatment of postoperative pneumonia.Methods9766patients undergone non-cardiothoracic surgical operations during June to September2013were collected. During the period from June2013to January2014,368patients undergone non-cardiothoracic surgical operations with a diagnosis of postoperative pneumonia, which with a comprehensive treatment including anti infection, auxiliary respiratory therapy, immune therapy, supportive therapy and sputum drainage. By logistic regression analysis to find out the influence of the related risk factors of postoperative pneumonia and prognosis.Results1. There were182patients with the diagnosis of postoperative pneumonia in the9766patients that undergone non-cardiothoracic surgical operations. The incidence rate was1.86%. There were35variables was considered influence of postoperative pneumonia. They were gender, age, obesity, state of consciousness, smoking index, cardiac functional grade, lung function grade, liver function grade, Renal function grade, malnutrition, anemia, preoperative latest test results of serum sodium, serum potassium, Serum chloride, blood calcium, hypertension, diabetes, high cholesterol, cerebrovascular disease, chronic obstructive pulmonary disease(COPD), other lung disease, preoperative glucocorticoid use, perioperative antibiotic overuse, tracheotomy, ASA, type of anesthesia, anesthesia time, operation type, operation site, operation level, blood loss, without postoperative analgesia with PCA, postoperative indwelling nasogastric tube, the use of acid secretion inhibitors. After single factor analysis of these variables, selected with statistical significance (P<0.05) variables using multivariate logistic regression analysis. The results showed that there are13independent risk factors related to postoperative pneumonia. According to the OR values descending order respectively are type of anesthesia(General anesthesia OR=4.621, P=0.014), COPD(OR=4.459, P＜0.001), operation site(Epigastrium OR=4.310, P＜0.001; Brain OR=3.286,P=0.001; Hypogastrium OR=2.228, P=0.001), state of consciousness(Severe coma OR=3.658, P=0.009), smoking index(>400OR=3.653, P＜0.001), Malnutrition(OR=3.272,P=0.034), perioperative antibiotic overuse(OR=3.194, P=0.008), diabetes(OR=2.812, P＜0.001), without postoperative analgesia with PCA(OR=2.294, P=0.036), obesity(OR=1.920, P=0.005), anesthesia time(OR=1.339, P＜0.001), blood loss (OR=1.031, P＜0.001), age(OR=1.019, P＜0.001).2. In368patients with postoperative pneumonia that with a comprehensive treatment, There were327patients had satisfactory prognosis and41patients with poor prognosis. The poor prognosis of the patients was11.1%. There were18variables was considered influence of postoperative pneumonia prognosis. They were gender, age, state of consciousness, smoking, the number underlying diseases, combined with multiple organ failure (MODS),mechanical ventilation, clinical pulmonary infection score (CPIS), liver function grade, renal function grade, the worst of clinical examination results of serum sodium, serum potassium, serum chloride, blood calcium, pH value, oxygen partial pressure(PO2), partial pressure of carbon dioxide(PCO2). After single factor analysis of these variables, selected with statistical significance(P<0.05) variables using multivariate logistic regression analysis. The results showed that there are8independent risk factors related to postoperative pneumonia prognosis. According to the OR values descending order respectively are mechanical ventilation (Invasive mechanical ventilation OR=5.129,P=0.005), albumin(<28g/1OR=4.912, P=0.007), MODS(OR=4.406, P=0.001), CPIS(>10OR=4.099, P=0.016), the number of underlying diseases(3～5, OR=3.807, P=0.010),pH value(AcidosisOR=3.450, P=0.007), age(>60OR=3.065, P=0.009), sodium(Hyponatremia OR=2.857, P=0.025).Conclusion1. with the increase of age, anesthesia time and blood loss, the increase in risk of patients with postoperative pneumonia.2. Type of anesthesia (General anesthesia), COPD、operation site (Epigastrium, Brain, Hypogastrium), state of consciousness (Severe coma), smoking index(>400), Malnutrition, perioperative antibiotic overuse, diabetes, without postoperative analgesia with PC A, obesity, anesthesia time, blood loss and age are independent risk factors of non-cardiothoracic surgery patients with postoperative pneumonia.3. Mechanical ventilation(Invasive mechanical ventilation), albumin(<28g/l), MODS, CPIS(>10), the number of underlying diseases(3～5), pH value(Acidosis), age(>60) and sodium(Hyponatremia) are independent risk factors of the prognosis of non-cardiothoracic surgery patients with postoperative pneumonia.