Khallikane Said, Seddiki Rachid, Serghini Issam
Anesthesiologist Cardiothoracic Anesthesia-Cardiovascular ICU, Anesthesiology-ICU-Emergency Department, Avicenna Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech 40000, Kingdom of Morocco., Marrakeck, Marrakech-Safi, 40000, Morocco.
Head chief of Hassan II Military Hospital, Professor of Anesthesiology-Critical Care, Avicenna Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech 40000, Kingdom of Morocco, Layun, Layun-Sakia Hamra, 70000, Morocco.
F1000Res. 2025 Jun 16;14:588. doi: 10.12688/f1000research.165457.1. eCollection 2025.
Postoperative infectious pneumonia (PIP) is a common and serious complication following cardiothoracic surgery, including coronary artery bypass grafting (CABG), valve interventions, and thoracic oncologic procedures. It is associated with increased morbidity, prolonged intensive care unit (ICU) stay, and healthcare burden.
We performed a systematic review and meta-analysis according to PRISMA 2020 guidelines. Studies published between January 2021 and December 2023 were identified from PubMed, Embase, and Scopus. Eligible studies reported the incidence and/or perioperative risk factors for PIP with odds ratios (ORs) and 95% confidence intervals (CIs). A random-effects model was used for pooled estimates. Study quality was assessed using the Newcastle-Ottawa Scale. The review was prospectively registered in PROSPERO 2025 CRD 420251057914. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251057914.
Six high-quality cohort studies involving 4,392 patients were included. The pooled incidence of PIP was 14.8% (95% CI, 10.6%-19.2%). Incidence was highest after thoracic oncologic surgery (17.2%), followed by valve surgery (15.8%) and CABG (13.5%). Significant risk factors included prolonged mechanical ventilation >48 hours (OR: 3.46), age >70 years (OR: 2.71), chronic obstructive pulmonary disease (OR: 2.95), cardiopulmonary bypass time >120 minutes (OR: 2.63), and left ventricular ejection fraction <40% (OR: 2.38). Heterogeneity was moderate (I = 46%) with no publication bias.
PIP remains a major postoperative concern. Identification of key risk factors enables targeted preventive strategies-early extubation, pulmonary optimization, and standardized care pathways-to reduce PIP incidence and improve outcomes.
术后感染性肺炎（PIP）是心胸外科手术后常见且严重的并发症，包括冠状动脉旁路移植术（CABG）、瓣膜干预手术及胸科肿瘤手术。它与发病率增加、重症监护病房（ICU）住院时间延长及医疗负担加重相关。
我们根据PRISMA 2020指南进行了系统评价和荟萃分析。从PubMed、Embase和Scopus数据库中检索2021年1月至2023年12月发表的研究。符合条件的研究报告了PIP的发病率和/或围手术期危险因素，并给出比值比（OR）和95%置信区间（CI）。采用随机效应模型进行合并估计。使用纽卡斯尔-渥太华量表评估研究质量。该综述已在PROSPERO 2025（CRD 420251057914）中进行前瞻性注册。可从https://www.crd.york.ac.uk/PROSPERO/view/CRD420251057914获取。
纳入了6项涉及4392例患者的高质量队列研究。PIP的合并发病率为14.8%（95%CI，10.6%-19.2%）。发病率在胸科肿瘤手术后最高（17.2%），其次是瓣膜手术（15.8%）和CABG（13.5%）。显著的危险因素包括机械通气时间延长>48小时（OR：3.46）、年龄>70岁（OR：2.71）、慢性阻塞性肺疾病（OR：2.95）、体外循环时间>120分钟（OR：2.63）以及左心室射血分数<40%（OR：2.38）。异质性为中度（I² = 46%），无发表偏倚。
PIP仍然是术后的主要关注点。识别关键危险因素有助于制定针对性的预防策略——早期拔管、优化肺部功能以及标准化护理路径——以降低PIP发病率并改善预后。
