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Worsens hospital outcome, prolongs hospital stay, and is associated with a significant increase in the cost of hospital care.
Increased risk include advanced age, American Society of Anesthesiologist class, the presence of COPD, functional status, preoperative sepsis, smoking within 1 year before operation, and the type of surgical procedure.
Postoperative pulmonary complications, especially pneumonia, take time to evolve, resulting in additional length of stay and hospital costs.
Compared to other postoperative complications respiratory complications are associated with the largest attributable cost and largest increase in hospital length of stay.
Postoperative pneumonia incidence varies from 9-40% in various older studies the pending upon the definition used.
In a recent study of 211,410 patients, postoperative pneumonia was seen in 1.81% of patients, and was associated with a 17% death rate within 30 days. (Gupta H et al).
In the above study 33% of the patients who developed postoperative pneumonia were re-intubated and 51% of patients were on the ventilator for more than 48 hours.
A VA Surgical Quality Improvement Program study had an incidence of postoperative pneumonia of 2.6% and a 30 day mortality in those patients of 21%.
In recent years there has been minimal change the incidence of postoperative pneumonia and its attendant mortality rate.
Patients with functional status limited capabilities in performing activities of daily living have prolonged hospitalization, increase morbidity and mortality, and are at greater risk for gram-negative and staphylococcal aureus colonization and aspiration pneumonia.
Advancing age is a risk factor for pneumonia due to decreased immunoglobulin formation, decreased cellular immune response, and increased colonization of the upper respiratory tract with gram-negative organisms.
Postoperative pneumonia is more common among the elderly due to loss of physiologic organ reserve an underlying silent organ dysfunction.
Patients with COPD have an increased incidence of postoperative pneumonia due to their impaired mucociliary clearance of aspirated bacteria.
Upper abdominal surgery thoracic procedures markedly alter pulmonary function tests and physiological pulmonary measurements predisposing to postoperative pneumonia.