Xiang Bingbing, Yi Mingliang, Li Chunyan, Yin Hong, Wang Shun, Liu Yiran
Department of Anesthesiology, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
Front Cell Infect Microbiol. 2024 Dec 24;14:1375298. doi: 10.3389/fcimb.2024.1375298. eCollection 2024.
Craniotomy is highly susceptible to postoperative pneumonia, which significantly impacts the outcomes of patients undergoing such procedures. Our study aims to examine the risk factors associated with postoperative pneumonia and establish a predictive model with a nomogram to assess this risk.
We conducted a matched 1:1 case-control study involving 831 adult patients undergoing craniotomy at our hospital. Cases consisted of patients who developed postoperative pneumonia within 30 days after surgery, as defined by consensus criteria. Controls were randomly selected from a pool of eligible patients.
The overall incidence rate of postoperative pneumonia is 12.39% in a total of 831 surgeries, which associated with unfavorable outcomes. Gram-negative bacteria were found to be the most common causative agents and approximately 27.94% of cases attributed to multi-drug resistant strains. The logistic regression analysis revealed five independent risk factors, as follows: smoking history, surgical duration, postoperative albumin, unplanned re-operation, and deep vein catheterization. A risk prediction model was derived and a nomogram was constructed. The Hosmer-Lemeshow test yielded X = 3.871 (P=0.869), and the receiver operator characteristic curve analysis demonstrated an area under the curve of 0.898 (P<0.05), with a sensitivity of 79.6% and a specificity of 85.4%, indicating excellent model fit and predictive performance. In addition, the C-index of the nomogram model was 0.898(95%CI, 0.853~0.941). The calibration curves of the nomogram model showed p-values of 0.797 and the Brier scores were 0.127. The analysis of the clinical decision curve showed that the nomograph model had high clinical application value.
Postoperative pneumonia patients after craniotomy exhibits distinct pathogen distribution and is strongly associated with unfavorable outcomes. The risk prediction model developed in this study demonstrates a good fitting degree and predictive performance. The constructed nomogram model is objective, specific, and easily applicable in clinical practice.
开颅手术极易引发术后肺炎，这对接受此类手术的患者的预后产生重大影响。我们的研究旨在探讨与术后肺炎相关的危险因素，并建立一个带有列线图的预测模型来评估这种风险。
我们进行了一项1:1匹配的病例对照研究，纳入了我院831例接受开颅手术的成年患者。病例组包括术后30天内发生符合共识标准定义的术后肺炎的患者。对照组从符合条件的患者中随机选取。
在总共831例手术中，术后肺炎的总体发生率为12.39%，这与不良预后相关。革兰氏阴性菌被发现是最常见的病原体，约27.94%的病例归因于多重耐药菌株。逻辑回归分析揭示了五个独立的危险因素，如下：吸烟史、手术时长、术后白蛋白水平、非计划再次手术以及深静脉置管。由此得出了一个风险预测模型并构建了列线图。Hosmer-Lemeshow检验得出X = 3.871（P = 0.869），受试者工作特征曲线分析显示曲线下面积为0.898（P < 0.05），灵敏度为79.6%，特异度为85.4%，表明模型拟合度和预测性能良好。此外，列线图模型的C指数为0.898（95%CI，0.853~0.941）。列线图模型的校准曲线显示p值为0.797，Brier评分是0.127。临床决策曲线分析表明列线图模型具有较高的临床应用价值。
开颅术后肺炎患者呈现出独特的病原体分布，并且与不良预后密切相关。本研究开发的风险预测模型显示出良好的拟合度和预测性能。构建的列线图模型客观、具体，且易于在临床实践中应用。
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