Postoperative pneumonia is the third most common complication in surgical patients. However, little is known regarding pneumonia after craniotomy, which is the most commonly performed surgery in the neurosurgery department.
To investigate the incidence of pneumonia and its association with the length of hospital stay, identify risk factors, and build a prediction model with nomogram.
The study population was based on the American College of Surgeons National Surgical Quality Improvement Program 2005-2017. Both multivariate logistic regression models and linear regression models were employed.
The overall incidence rate of postoperative pneumonia is 3.11% in a total of 57,201 surgeries. The risk factors include age >55, male, lower body mass index, diabetes, functional dependent, ventilator dependence, history of severe chronic obstructive pulmonary disease, hypertension, systemic sepsis, white blood cells >12,000, emergency case, American Society of Anesthesiologists class ≥3, general anesthesia, and total operation time >240 min. Ten featured factors are used in nomogram (C-statistic 0.803). Postoperative pneumonia was associated with extended hospital stay. Compared to other postoperative complications, pneumonia showed the second-highest impact on the extension of hospital stay (4.7 days).
This study identified several preoperative risk factors for postoperative pneumonia after craniotomy, novel factors including male, low BMI warrants further investigation. The novel nomogram could serve as a reliable tool for evaluating postoperative pneumonia risk preoperatively.

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