Risk factors for pneumonia after radical gastrectomy for gastric cancer: a systematic review and meta-analysis.

OBJECTIVE

The objective is to systematically gather relevant research to determine and quantify the risk factors and pooled prevalence for pneumonia after a radical gastrectomy for gastric cancer.

METHODS

The reporting procedures of this meta-analysis conformed to the PRISMA 2020. Chinese Wan Fang data, Chinese National Knowledge Infrastructure (CNKI), Chinese Periodical Full-text Database (VIP), Embase, Scopus, CINAHL, Ovid MEDLINE, PubMed, Web of Science, and Cochrane Library from inception to January 20, 2024, were systematically searched for cohort or case-control studies that reported particular risk factors for pneumonia after radical gastrectomy for gastric cancer. The pooled prevalence of pneumonia was estimated alongside risk factor analysis. The quality was assessed using the Newcastle-Ottawa Scale after the chosen studies had been screened and the data retrieved. RevMan 5.4 and R 4.4.2 were the program used to perform the meta-analysis.

RESULTS

Our study included data from 20,840 individuals across 27 trials. The pooled prevalence of postoperative pneumonia was 11.0% (95% CI = 8.0% ~ 15.0%). Fifteen risk factors were statistically significant, according to pooled analyses. Several factors were identified to be strong risk factors, including smoking history (OR 2.71, 95% CI = 2.09 ~ 3.50, I = 26%), prolonged postoperative nasogastric tube retention (OR 2.25, 95% CI = 1.36-3.72, I = 63%), intraoperative bleeding ≥ 200 ml (OR 2.21, 95% CI = 1.15-4.24, I = 79%), diabetes mellitus (OR 4.58, 95% CI = 1.84-11.38, I = 96%), male gender (OR 3.56, 95% CI = 1.50-8.42, I = 0%), total gastrectomy (OR 2.59, 95% CI = 1.83-3.66, I = 0%), COPD (OR 4.72, 95% CI = 3.80-5.86, I = 0%), impaired respiratory function (OR 2.72, 95% CI = 1.58-4.69, I = 92%), D2 lymphadenectomy (OR 4.14, 95% CI = 2.29-7.49, I = 0%), perioperative blood transfusion (OR 4.21, 95% CI = 2.51-7.06, I = 90%), and hypertension (OR 2.21, 95% CI = 1.29-3.79, I = 0%). Moderate risk factors included excessive surgery duration (OR 1.51, 95% CI = 1.25-1.83, I = 90%), advanced age (OR 1.91, 95% CI = 1.42-2.58, I = 94%), nutritional status (OR 2.62, 95% CI = 1.55-4.44, I = 71%), and history of pulmonary disease (OR 1.61, 95% CI = 1.17-2.21, I = 79%).

CONCLUSIONS

This study identified 15 independent risk factors significantly associated with pneumonia after radical gastrectomy for gastric cancer, with a pooled prevalence of 11.0%. These findings emphasize the importance of targeted preventive strategies, including preoperative smoking cessation, nutritional interventions, blood glucose and blood pressure control, perioperative respiratory training, minimizing nasogastric tube retention time, and optimizing perioperative blood transfusion strategies. For high-risk patients, such as the elderly, those undergoing prolonged surgeries, experiencing excessive intraoperative blood loss, undergoing total gastrectomy, or receiving open surgery, close postoperative monitoring is essential. Early recognition of pneumonia signs and timely intervention can improve patient outcomes and reduce complications.