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Risk Factors for Postoperative Pneumonia After Cardiac Surgery and Development of a Preoperative Risk Score*

Allou, Nicolas MD1,2; Bronchard, Regis MD1; Guglielminotti, Jean MD, PhD1,2; Dilly, Marie Pierre MD1; Provenchere, Sophie MD1; Lucet, Jean Christophe MD, PhD2,3; Laouénan, Cédric MD2,4; Montravers, Philippe MD, PhD1,2

Critical Care Medicine:
doi: 10.1097/CCM.0000000000000143
Clinical Investigations
Abstract

Objectives: The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia.

Design and Setting: A single-center cohort study.

Patients: All consecutive patients undergoing cardiac surgery between January 2006 and July 2011.

Interventions: None.

Measurements and Main Results: Multivariate analysis of risk factors for postoperative pneumonia was performed on data from patients operated between January 2006 and December 2008 (training set). External temporal validation was performed on data from patients operated between January 2009 and July 2011 (validation set). Preoperative variables identified in multivariate analysis of the training set were then used to develop a preoperative scoring system that was validated on the validation set. Postoperative pneumonia occurred in 174 of the 5,582 patients (3.1%; 95% CI, 2.7–3.6). Multivariate analysis identified four risk factors for postoperative pneumonia: age (odds ratio, 1.02; 95% CI, 1.01–1.03), chronic obstructive pulmonary disease (odds ratio, 2.97; 95% CI, 1.8–4.71), preoperative left ventricular ejection fraction (odds ratio, 0.98; 95% CI, 0.96–0.99), and the interaction between RBC transfusion during surgery and duration of cardiopulmonary bypass (odds ratio, 2.98; 95% CI, 1.96–4.54). A 6-point score including the three preoperative variables then defined two risk groups corresponding to postoperative pneumonia rates of 1.8% (score < 3) and 6.5% (score ≥ 3).

Conclusion: Assessing preoperative risk factors for postoperative pneumonia with the proposed scoring system could help to implement a preventive policy in high-risk patients with a risk of postoperative pneumonia greater than 4% (i.e., patients with a score ≥3).

Author Information

1Département d’Anesthésie-Réanimation, CHU Bichat-Claude Bernard, Université Paris VII, Assistance Publique Hopitaux de Paris, France.

2Université Paris Diderot, Sorbonne Paris Cité, Paris, France.

3Unité d’Hygiène et de lutte Contre les Infections Hospitalières, CHU Bichat-Claude Bernard, Université Paris VII, Assistance Publique Hopitaux de Paris, France.

4Service de Biostatistique, F-75018, CHU Bichat-Claude Bernard, Université Paris VII, Assistance Publique Hopitaux de Paris, France.

* See also p. 1302.

Drs. Allou, Bronchard, and Guglielminotti had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Allou, Bronchard, Guglielminotti, and Montravers contributed to study concept and design. Drs. Bronchard, Allou, Provenchere, Dilly, and Lucet contributed to acquisition of data. Drs. Allou, Bronchard, Montravers, and Guglielminotti contributed to analysis and interpretation of data. Drs. Allou, Montravers, Guglielminotti, and Bronchard contributed to drafting of the article. Drs. Allou, Bronchard, Guglielminotti, and Montravers contributed to critical revision of the article for important intellectual content. Drs. Guglielminotti and Laouénan contributed to statistical analysis. Drs. Allou, Bronchard, Guglielminotti, Dilly, Provenchere, Lucet, and Montravers contributed to administrative, technical, or material support. Drs. Allou, Montravers, Guglielminotti, and Bronchard contributed to study supervision.

Supported, in part, by internal funds.

Presented, in part, at the 24th annual congress of the European Society of Intensive Care Medicine, Berlin, Germany, October, 2011.

Dr. Montravers consulted for Pfizer, Merck, Astellas, and AstraZeneca; received support for participation in review activity from Astellas; served as a board member for Pfizer, Merck, and Astellas; provided expert testimony for Aguettant; and lectured for Pfizer. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: nicolas.allou@hotmail.fr

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins