Objective: Postoperative pneumonia in critically ill patients is becoming an important cause for adverse clinical outcomes. It is very important to predict postoperative pneumonia. Surgical Intensive Care Unit(SICU), is an intensive care unit that deals with post-surgical patients, and is usually staffed by a team of surgeons, critical care specialists, and nurses to provide close monitoring and care. The purpose of this study is to investigate the risk factors of postoperative pneumonia in patients in SICU after surgery, establish a risk prediction model, and help surgeons and SICU doctors to early identify patients with high-risk postoperative pneumonia.
Methods: To explore risk factors for postoperative pneumonia, Patients in the SICU from January 1, 2019, to December 31, 2019, were collected and retrospectively analyzed. The data were randomly divided into a derivation set (n=533) and a validation set (n=277). Patients were divided into postoperative pneumonia (PP) group and non-postoperative pneumonia (NPP) group. t test and Chi-square test were used to compare the differences between the PP and NPP groups before and after surgery. The risk factors of postoperative pneumonia in SICU patients were identified using univariate and multivariate logistic regression. A derivation set was used to build the model, and a validation set was used for model evaluation. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the model performance. The model was validated by AUC using a validation set.
Results: With this model, a total of 8 independent risk factors were identified to be associated with postoperative pneumonia in SICU patients after surgery. Patients with the 8 risk factors were assigned the following scores: recorded aspiration: 8, preoperative disturbance of consciousness: 4, thoracic and abdominal surgery: 3, contaminated wound: 10, abnormal choking cough on SICU admission: 9, abnormal pulmonary auscultation on SICU admission: 5, postoperative sedation, 4 points, and postoperative analgesia >1 day: 3. Eight risk factors were significantly correlated with postoperative pneumonia. Based on the scoring standard above, a risk factor table was created using the 8 predictors with a total score of 46. The AUC was 0.933 and 0.908 in derivation set and validation set. A cumulative score > 12 indicates high risk of postoperative pneumonia.
Conclusions: This study identified 8 risk factors that are significantly associated with postoperative pneumonia in SICU patients after surgery and provides operable clinical tools for early prevention and intervention of postoperative pneumonia. The implementation of this model has significant potential to enhance patient outcomes in the SICU by enabling early identification and stratification of patients at elevated risk of developing postoperative pneumonia. This model allows for the timely initiation of targeted preventative and therapeutic interventions, potentially reducing the incidence of pneumonia, shortening hospital stays, and improving overall patient survival rates. Furthermore, the use of a cumulative scoring system, simplifies clinical decision-making, making it accessible and actionable for surgeons and SICU staff.