Surgical risk factors for post-operative pneumonia following meningioma resection

Objective Post-operative pneumonia (PNA) is a significant cause of surgically associated morbidity and mortality. We aimed to identify intraoperative factors during meningioma surgery that were associated with a high risk of post-operative PNA to risk-stratify patients and improve outcomes. Methods We conducted an institutional retrospective review on all patients who underwent craniotomies for meningioma between 2009 and 2012. Using medical records, we extracted patient demographics, tumor characteristics, tumor pathology, surgical positioning, procedure duration, estimated blood loss (EBL), and the occurrence of post-operative PNA. Results In our series, 464 patients underwent craniotomy for meningioma. There was a female predominance (331 women, 133 men), with mean age of 58 ± 13 years (range 18-92). There were 354 grade I, 79 grade II, and 30 grade III tumors. Overall, 1.3% of patients developed PNA. Patient age (p = 0.01), procedure duration (p < 0.01), and blood loss (p = 0.02) were associated with increased incidence of PNA. The development of post-operative PNA resulted in a significantly increased duration of hospital stay (19 ± 7 vs. 7 ± 7 days, p = 0.00). In multivariate analysis, patient age (OR = 1.13, CI: 1.04-1.22; p = 0.004), EBL (OR = 1.01, CI: 1.00-1.02; p = 0.023), and procedure duration (OR = 1.06, CI: 1.01-1.11; p = 0.012) were significant predictors of development of PNA. Conclusions Patient age and procedure duration are significantly associated with post-operative PNA following meningioma resection, which results in prolonged hospitalization. Efforts to minimize operative times and EBL, especially in the elderly, may reduce PNA rates and hospitalization time.