Impact of postoperative pneumonia following pituitary surgery

Abstract

Objectives/hypothesis: Postoperative pneumonia (PNA) has been identified as a preventable never event by the Centers for Medicare and Medicaid Services (CMS). The CMS has discussed possibly discontinuing reimbursement for this postoperative complication. In this study, risk factors, patient outcomes, and hospital charges of care associated with postoperative PNA in patients undergoing pituitary surgery were evaluated.

Methods: Discharge data of patients who underwent pituitary surgery between 2002 and 2010 were obtained from the National Inpatient Sample database. Demographics, preexisting comorbidities, postoperative complications, morbidity, length of hospital stay, and hospital charges were analyzed.

Results: A total of 15,317 patients were included in this analysis. Ninety-eight patients (0.6%) were diagnosed with PNA postoperatively. There was a significant association between postoperative PNA and older age (P < 0.001), male gender (P = 0.044), and transfrontal surgical approach (P < 0.001). Patients with anemia, congestive heart failure, chronic pulmonary disease, diabetes mellitus, fluid and electrolyte disorders, paralysis, and weight loss had a significantly higher rate of PNA. Patients with PNA had a significantly higher mortality (P < 0.001). They also incurred on average over four times the hospital charges and nearly five times longer hospitalizations compared to patients without PNA.

Conclusions: Variables associated with an increased risk of postoperative PNA in patients undergoing pituitary surgery include older age, male gender, and transfrontal surgical approach. Patients with postoperative PNA had a longer length of hospital stay, higher hospital charges, and increased mortality.

Level of evidence: 2C.

Keywords: Pituitary surgery; aspiration pneumonia; benign pituitary neoplasm; hospital complications; infectious pneumonia; nationwide inpatient sample; pituitary tumor; transfrontal; transsphenoidal; ventilator-associated pneumonia.