Postoperative Pneumonia in Major Head and Neck Cancer Surgery

The incidence of postoperative pneumonia (PPNA) in patients undergoing major head and neck cancer surgery has not been well established. Patients who developed PPNA undergoing major head and neck cancer (HNC) surgery from the Nationwide Inpatient Sample (NIS) from the years 2017 to 2019 (n = 10 037) were analyzed using ICD-10 codes. PPNA developed in 2.8% (n = 285) of patients undergoing major HNC surgery. PPNA patients had longer hospitalizations (15 [10-24] vs. 6 [3-9] days, p < 0.001; median, IQR) and had greater hospital charges (241 308 [166 976-382 982] vs. 104 697 [59 640-181 760], p < 0.001; USD; median, IQR). Regression models revealed that anemia was the greatest predisposing factor for PPNA (OR: 3.3, 95% CI: 2.6-4.2) among other comorbidities such as COPD (OR: 2.0, 95% CI: 1.6-2.7), hypertension (OR: 1.3, 95% CI: 1.0-1.7), and dementia (OR: 1.4, 95% CI: 1.0-1.9). In one of the population's largest data sets, anemia and COPD were the strongest contributing factors to developing PPNA for HNC patients. PPNA was the strongest predictor of increased length of stay and hospital charges in patients undergoing major HNC surgery. Surgical pathways should directly target decreasing PPNA rates to improve outcomes and lower costs.