Trinh Vincent Q, Ravi Praful, Abd-El-Barr Abd-El-Rahman M, Jhaveri Jay K, Gervais Mai-Kim, Meyer Christian P, Hanske Julian, Sammon Jesse D, Trinh Quoc-Dien
Departement of Pathology and Cellular Biology, University of Montreal Health Center, Montreal, QC, Canada H2X 0A9.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Can Respir J. 2016;2016:6019416. doi: 10.1155/2016/6019416. Epub 2016 May 31.
Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS). Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS), a Healthcare Cost and Utilization Project (HCUP) subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC) of mortality after MCS was -2.4% (95% CI: -2.9 to -2.0, P < 0.001); the EAPC of mortality associated with pneumonia after MCS was -2.2% (95% CI: -3.6 to 0.9, P = 0.01). Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.
理论依据。肺炎是术后并发症的主要原因。目的。研究大型癌症手术（MCS）后肺炎的趋势、影响因素及死亡率。方法。1999年至2009年期间，使用全国住院患者样本（NIS）（医疗保健成本和利用项目（HCUP）的一个子集）确定接受主要形式MCS的患者，最终得到加权后的2508916例患者。测量指标。使用广义估计方程进行聚类调整的逻辑回归分析来检查决定因素。结果。1999年至2009年期间，87867例患者在MCS后发生肺炎，患病率增加了29.7%。MCS后死亡率的估计年变化百分比（EAPC）为-2.4%（95%CI：-2.9至-2.0，P<0.001）；MCS后与肺炎相关的死亡率的EAPC为-2.2%（95%CI：-3.6至0.9，P=0.01）。与肺炎发生几率较高相关的特征包括年龄较大、男性、合并症、非私人保险、低收入、医院规模、城市、东北地区和非教学医院。肺炎使死亡几率高出6.3倍。结论。MCS后肺炎患病率增加，而死亡率稳定，这可能是由于诊断增加或编码更严格所致。我们确定了MCS后与肺炎相关的特征，这有助于识别高危患者，以降低MCS后肺炎的发生率，因为肺炎会大大增加死亡几率。
