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Erschienen in: World Journal of Surgery 6/2008

01.06.2008

Incidence and Risk Factors for Hospital-acquired Pneumonia After Surgery for Gastric Cancer: Results of Prospective Surveillance

verfasst von: Yasuhiko Mohri, Hitoshi Tonouchi, Chikao Miki, Minako Kobayashi, Masato Kusunoki, Mie Surgical Infection Research Group

Erschienen in: World Journal of Surgery | Ausgabe 6/2008

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Abstract

Background

Postoperative hospital-acquired pneumonia (HAP) is recognized as a major risk associated with surgery. Although upper abdominal surgery is known to have the highest incidence of postoperative HAP, little is known about the risk factors that contribute to HAP after gastric cancer surgery. The aim of this study was to determine the incidence and risk factors for HAP after elective surgery for gastric cancer.

Methods

We conducted prospective surveillance of all elective gastric resections by surgeons in ten affiliated hospitals, including ours, from May 2001 to May 2005. The outcome of interest was postoperative HAP. Univariate and multivariate analyses were performed to determine the predictive significance of variables in gastric cancer surgery.

Results

A total of 529 patients undergoing elective operations for gastric cancer were admitted to the program. Postoperative HAP was identified in 20 patients (3.6%). Univariate and multivariate analyses showed that male gender and intra- and/or postoperative blood transfusion were independently predictive of postoperative HAP.

Conclusions

Male gender and intra- and/or postoperative blood transfusion were independent risk factors for the development of HAP after elective resection of gastric cancer. Surgeons should keep these risk factors in mind when managing postoperative patients.
Literatur
1.
2.
Zurück zum Zitat Baker JJ, Lambert RL, Poulos KM et al (2000) Managing the cost of care: a predictive study to identify critical care patients at risk for nosocomial pneumonia. J Health Care Finance 26:73–82PubMed Baker JJ, Lambert RL, Poulos KM et al (2000) Managing the cost of care: a predictive study to identify critical care patients at risk for nosocomial pneumonia. J Health Care Finance 26:73–82PubMed
3.
Zurück zum Zitat Baughman RP, Tapson V, McIvor A (1999) The diagnosis and treatment challenges in nosocomial pneumonia. Diagn Microbiol Infect Dis 33:131–139PubMedCrossRef Baughman RP, Tapson V, McIvor A (1999) The diagnosis and treatment challenges in nosocomial pneumonia. Diagn Microbiol Infect Dis 33:131–139PubMedCrossRef
4.
Zurück zum Zitat Ephgrave KS, Kleiman-Wexler R, Pfaller M et al (1993) Postoperative pneumonia: a prospective study of risk factors and morbidity. Surgery 114:815–819PubMed Ephgrave KS, Kleiman-Wexler R, Pfaller M et al (1993) Postoperative pneumonia: a prospective study of risk factors and morbidity. Surgery 114:815–819PubMed
5.
Zurück zum Zitat Fujita T, Sakurai K (1995) Multivariate analysis of risk factors for postoperative pneumonia. Am J Surg 169:304–307PubMedCrossRef Fujita T, Sakurai K (1995) Multivariate analysis of risk factors for postoperative pneumonia. Am J Surg 169:304–307PubMedCrossRef
6.
Zurück zum Zitat Richardson JD, DeCamp MM, Garrison RN et al (1982) Pulmonary infection complicating intra-abdominal sepsis: clinical and experimental observations. Ann Surg 195:732–738PubMedCrossRef Richardson JD, DeCamp MM, Garrison RN et al (1982) Pulmonary infection complicating intra-abdominal sepsis: clinical and experimental observations. Ann Surg 195:732–738PubMedCrossRef
7.
Zurück zum Zitat Montravers P, Veber B, Auboyer C et al (2002) Diagnostic and therapeutic management of nosocomial pneumonia in surgical patients: results of the Eole study. Crit Care Med 30:368–375PubMedCrossRef Montravers P, Veber B, Auboyer C et al (2002) Diagnostic and therapeutic management of nosocomial pneumonia in surgical patients: results of the Eole study. Crit Care Med 30:368–375PubMedCrossRef
8.
Zurück zum Zitat Hall JC, Tarala RA, Hall JL et al (1991) A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest 99:923–927PubMedCrossRef Hall JC, Tarala RA, Hall JL et al (1991) A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest 99:923–927PubMedCrossRef
9.
Zurück zum Zitat AHRQ (2003) AHRQ’s patient safety initiative: building foundations, reducing risk. Interin report to the senate committee on appropriations, 04-RG005. AHRQ Publications, Rockville, MD AHRQ (2003) AHRQ’s patient safety initiative: building foundations, reducing risk. Interin report to the senate committee on appropriations, 04-RG005. AHRQ Publications, Rockville, MD
10.
Zurück zum Zitat Garner JS, Jarvis WR, Emori TG et al (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140PubMedCrossRef Garner JS, Jarvis WR, Emori TG et al (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140PubMedCrossRef
11.
Zurück zum Zitat Carven DE, Steger KA, Barber TW (1991) Preventing nosocomial pneumonia: state of the art and perspective for the 1990’s. Am J Med 91(3B):44S–53SCrossRef Carven DE, Steger KA, Barber TW (1991) Preventing nosocomial pneumonia: state of the art and perspective for the 1990’s. Am J Med 91(3B):44S–53SCrossRef
12.
Zurück zum Zitat Mandell LA, Marrie TJ, Niederman MS et al (1993) Initial antimicrobial treatment of hospital acquired pneumonia in adults: a conference report. Can J Infect Dis 4:317–321 Mandell LA, Marrie TJ, Niederman MS et al (1993) Initial antimicrobial treatment of hospital acquired pneumonia in adults: a conference report. Can J Infect Dis 4:317–321
13.
Zurück zum Zitat American Thoracic Society (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, November 1995. Am J Respir Crit Care Med 153(5):1711–1725 American Thoracic Society (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, November 1995. Am J Respir Crit Care Med 153(5):1711–1725
14.
Zurück zum Zitat Delgado-Rodriguez M, Medina-Cuadros M, Martinez-Gallego G et al (1997) Usefulness of intrinsic surgical wound infection risk indices as predictors of postoperative pneumonia risk. J Hosp Infect 35:269–276PubMedCrossRef Delgado-Rodriguez M, Medina-Cuadros M, Martinez-Gallego G et al (1997) Usefulness of intrinsic surgical wound infection risk indices as predictors of postoperative pneumonia risk. J Hosp Infect 35:269–276PubMedCrossRef
15.
Zurück zum Zitat Garibaldi RA, Britt MR, Cleman ML et al (1981) Risk factors for postoperative pneumonia. Am J Med 70:677–680PubMedCrossRef Garibaldi RA, Britt MR, Cleman ML et al (1981) Risk factors for postoperative pneumonia. Am J Med 70:677–680PubMedCrossRef
16.
Zurück zum Zitat Thompson DA, Makary MA, Dorman T et al (2006) Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg 243:547–552PubMedCrossRef Thompson DA, Makary MA, Dorman T et al (2006) Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg 243:547–552PubMedCrossRef
17.
18.
Zurück zum Zitat Brooks-Brunn JA (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111:564–571PubMedCrossRef Brooks-Brunn JA (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111:564–571PubMedCrossRef
19.
Zurück zum Zitat Mitchell CK, Smoger SH, Pfeifer MP et al (1998) Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg 133:194–198PubMedCrossRef Mitchell CK, Smoger SH, Pfeifer MP et al (1998) Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg 133:194–198PubMedCrossRef
20.
Zurück zum Zitat Heiss MM, Mempel W, Jauch KW et al (1993) Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery. Lancet 342:1328–1333PubMedCrossRef Heiss MM, Mempel W, Jauch KW et al (1993) Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery. Lancet 342:1328–1333PubMedCrossRef
21.
Zurück zum Zitat Jansen LS, Andersen AJ, Christiansen PM et al (1992) Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br J Surg 79:513–516CrossRef Jansen LS, Andersen AJ, Christiansen PM et al (1992) Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br J Surg 79:513–516CrossRef
22.
Zurück zum Zitat Braga M, Vignali A, Radaelli G et al (1992) Association between perioperative blood transfusion and postoperative infection in patients having elective operations for gastrointestinal cancer. Eur J Surg 158:531–536PubMed Braga M, Vignali A, Radaelli G et al (1992) Association between perioperative blood transfusion and postoperative infection in patients having elective operations for gastrointestinal cancer. Eur J Surg 158:531–536PubMed
23.
Zurück zum Zitat Pinto V, Baldonedo R, Nicolas C et al (1991) Relationship of transfusion and infectious complications after gastric carcinoma operations. Transfusion 31:114–118PubMedCrossRef Pinto V, Baldonedo R, Nicolas C et al (1991) Relationship of transfusion and infectious complications after gastric carcinoma operations. Transfusion 31:114–118PubMedCrossRef
24.
Zurück zum Zitat Ford CD, Van Moorleghem G, Menlove RL (1993) Blood transfusions and postoperative wound infection. Surgery 113:603–607PubMed Ford CD, Van Moorleghem G, Menlove RL (1993) Blood transfusions and postoperative wound infection. Surgery 113:603–607PubMed
25.
Zurück zum Zitat Carson JL, Altman DG, Duff A et al (1999) Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip-fracture repair. Transfusion 39:694–700PubMedCrossRef Carson JL, Altman DG, Duff A et al (1999) Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip-fracture repair. Transfusion 39:694–700PubMedCrossRef
26.
Zurück zum Zitat Innerhofer P, Walleczek C, Luz G et al (1999) Transfusion of buffy coat-depleted blood components and risk of postoperative infection in orthopedic patients. Transfusion 39:625–632PubMedCrossRef Innerhofer P, Walleczek C, Luz G et al (1999) Transfusion of buffy coat-depleted blood components and risk of postoperative infection in orthopedic patients. Transfusion 39:625–632PubMedCrossRef
27.
Zurück zum Zitat Vamvakas EC, Carven JH (1998) Transfusion of white-cell containing allogeneic blood components and postoperative wound infection: effect of confounding factors. Transfus Med 8:29–36PubMedCrossRef Vamvakas EC, Carven JH (1998) Transfusion of white-cell containing allogeneic blood components and postoperative wound infection: effect of confounding factors. Transfus Med 8:29–36PubMedCrossRef
28.
Zurück zum Zitat Bellantone R, Sitges-Serra A, Bossola M et al (1998) Transfusion timing and postoperative septic complications after gastric cancer surgery a retrospective study of 179 consecutive patients. Arch Surg 133:988–992PubMedCrossRef Bellantone R, Sitges-Serra A, Bossola M et al (1998) Transfusion timing and postoperative septic complications after gastric cancer surgery a retrospective study of 179 consecutive patients. Arch Surg 133:988–992PubMedCrossRef
29.
Zurück zum Zitat Arozullah AM, Khuri SF, Henderson WG et al (2001) Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 135:847–857PubMed Arozullah AM, Khuri SF, Henderson WG et al (2001) Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 135:847–857PubMed
30.
Zurück zum Zitat Konard F, Wiedeck H, Kilian J et al (1991) A multivariate analysis of the risk of pulmonary complications after laparotomy. Anaesthesist 40:483–490 Konard F, Wiedeck H, Kilian J et al (1991) A multivariate analysis of the risk of pulmonary complications after laparotomy. Anaesthesist 40:483–490
31.
Zurück zum Zitat Brooks-Brunn JA (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111:564–571PubMedCrossRef Brooks-Brunn JA (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111:564–571PubMedCrossRef
32.
Zurück zum Zitat Dal Nogare AR (1994) Nosocomial pneumonia in the medical and surgical patient. Risk factors and primary management. Med Clin North Am 78:1081–1090PubMed Dal Nogare AR (1994) Nosocomial pneumonia in the medical and surgical patient. Risk factors and primary management. Med Clin North Am 78:1081–1090PubMed
33.
Zurück zum Zitat Mitchell CK, Smoger SH, Pfeifer MP et al (1998) Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg 133:194–198PubMedCrossRef Mitchell CK, Smoger SH, Pfeifer MP et al (1998) Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg 133:194–198PubMedCrossRef
Metadaten
Titel
Incidence and Risk Factors for Hospital-acquired Pneumonia After Surgery for Gastric Cancer: Results of Prospective Surveillance
verfasst von
Yasuhiko Mohri
Hitoshi Tonouchi
Chikao Miki
Minako Kobayashi
Masato Kusunoki
Mie Surgical Infection Research Group
Publikationsdatum
01.06.2008
Verlag
Springer-Verlag
Erschienen in
World Journal of Surgery / Ausgabe 6/2008
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-008-9534-8

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