Incidence and risk factors of postoperative pneumonia following cancer surgery in adult patients with selected solid cancer: results of “Cancer POP” study

Abstract

The aim of this study was to investigate the incidence and risk factors of postoperative pneumonia (POP) within 1 year after cancer surgery in patients with the five most common cancers (gastric, colorectal, lung, breast cancer, and hepatocellular carcinoma [HCC]) in South Korea. This was a multicenter and retrospective cohort study performed at five nationwide cancer centers. The number of cancer patients in each center was allocated by the proportion of cancer surgery. Adult patients were randomly selected according to the allocated number, among those who underwent cancer surgery from January to December 2014 within 6 months after diagnosis of cancer. One‐year cumulative incidence of POP was estimated using Kaplan–Meier analysis. An univariable Cox's proportional hazard regression analysis was performed to identify risk factors for POP development. As a multivariable analysis, confounders were adjusted using multiple Cox's PH regression model. Among the total 2000 patients, the numbers of patients with gastric cancer, colorectal cancer, lung cancer, breast cancer, and HCC were 497 (25%), 525 (26%), 277 (14%), 552 (28%), and 149 (7%), respectively. Overall, the 1‐year cumulative incidence of POP was 2.0% (95% CI, 1.4–2.6). The 1‐year cumulative incidences in each cancer were as follows: lung 8.0%, gastric 1.8%, colorectal 1.0%, HCC 0.7%, and breast 0.4%. In multivariable analysis, older age, higher Charlson comorbidity index (CCI) score, ulcer disease, history of pneumonia, and smoking were related with POP development. In conclusions, the 1‐year cumulative incidence of POP in the five most common cancers was 2%. Older age, higher CCI scores, smoker, ulcer disease, and previous pneumonia history increased the risk of POP development in cancer patients.

Preoperative oral care and effect on postoperative complications after major cancer surgery

“…Because the intervention of preoperative oral care by a dentist was not standardized, the quality of the procedures was dependent on the specific hospital or dentist. No data were obtained on several potential confounders, including BMI, smoking status and functional dependency. The results may not be generalizable to other countries because the study included only Japanese patients.…”

“…The study analysed approximately 500 000 patients, representing almost all those undergoing major cancer surgery in Japan. It was possible to adjust for numerous factors to eliminate potential confounders, including several previously reported confounding factors (age, sex, hypertension, diabetes mellitus, pulmonary disease, type of surgery and poor general condition).…”

<p>Preoperative Serum Albumin Level As A Predictor Of Postoperative Pneumonia After Femoral Neck Fracture Surgery In A Geriatric Population</p>

“…Prior studies have identified numerous patient-related or procedure-related risk factors for POP after femoral neck fracture surgery. In most but not all studies, multiple variables, including older age, male sex, and the presence of several key clinical comorbidities such as chronic obstructive pulmonary disease (COPD), 5 obesity, 7,8 tobacco smoking, 9 prior stroke, 3 impaired preoperative pulmonary function, 10,11 cognitive and functional premorbid status 12 and cardiovascular disease 3 have been identified as risk factors for POP.…”

Smoking is associated with pneumonia development in lung cancer patients

“…Agostini et al [16] have noted that smoking increases postoperative pulmonary complications such as increased hospital mortality, intensive care unit admission rate, and hospital length of stay. Jung et al [32] have also shown that smoking is one of independent risk factors for the development of post-operative pneumonia in cancer patients.…”