Postoperative Infectious Pneumonia in Cardiothoracic Surgery: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiothoracic Surgery
• Pulmonary Medicine
• Critical Care Medicine

Background:

• Postoperative infectious pneumonia (PIP) is a significant complication after cardiothoracic procedures.
• It leads to increased morbidity, longer intensive care unit (ICU) stays, and higher healthcare costs.

Purpose of the Study:

• To systematically review and meta-analyze the incidence of PIP.
• To identify perioperative risk factors associated with PIP following cardiothoracic surgery.

Main Methods:

• Systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
• Searched PubMed, Embase, and Scopus for studies from January 2021 to December 2023.
• Included six high-quality cohort studies with 4,392 patients; assessed quality using the Newcastle-Ottawa Scale.

Main Results:

• The pooled incidence of PIP was 14.8% (95% CI, 10.6%-19.2%).
• Incidence varied by procedure type: thoracic oncologic (17.2%), valve surgery (15.8%), and CABG (13.5%).
• Significant risk factors identified: prolonged mechanical ventilation >48h (OR: 3.46), age >70 (OR: 2.71), COPD (OR: 2.95), cardiopulmonary bypass >120min (OR: 2.63), LVEF <40% (OR: 2.38).

Conclusions:

• PIP remains a critical postoperative challenge in cardiothoracic surgery.
• Identifying risk factors allows for targeted preventive strategies.
• Strategies include early extubation, pulmonary optimization, and standardized care pathways to reduce PIP incidence and improve patient outcomes.