Prevention of Postoperative Pneumonia

Hospital Physician September 2007 47 H ospital-acquired pneumonia (HAP) is defined as pneumonia that develops 48 hours or more after hospital admission, which was not incubating at the time of admission (Table 1). Ventilator-associated pneumonia (VAP) refers to pneumonia that develops more than 48 to 72 hours after endotracheal intubation. Postoperative pneumonia is HAP or VAP that occurs in a postoperative patient. HAP is the second most common nosocomial infection in the United States after urinary tract infection but is the leading cause of mortality attributed to nosocomial infection.1 Furthermore, HAP prolongs hospital stays for an average of 7 to 9 days and adds excess medical costs ranging from $12,000 to $40,000 per patient.2–4 “Attributable mortality” from HAP is estimated to be between 33% and 50%.5–7 There is convincing evidence that specific interventions can be employed to prevent HAP/VAP and postoperative pneumonia. The higher morbidity, hospital mortality, and excess hospital costs attributable to these infections should make implementation of preventive strategies a priority among hospitals. Mandatory education programs for health care workers caring for postoperative patients, adherence to infectioncontrol practices, and surveillance of local nosocomial infection rates are all important strategies for effective prevention of postoperative pneumonia. This article, which is the second in a series addressing recent evidence-based recommendations for improving the quality and safety of surgical care, reviews the etiology, pathogenesis, and prevention of postoperative pneumonia. In addition, an illustrative case is provided to demonstrate the approach to evaluating and treating a patient with postoperative pneumonia.