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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.

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