title: Surgical risk factors for post-operative pneumonia following meningioma resection.
abstract: 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.
authors: Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors: Taemin
authors: T
authors: Oh
authors: Department of Neurological Surgery, University of California, San Francisco, USA.
authors: Michael
authors: M
authors: Safaee
authors: Department of Neurological Surgery, University of California, San Francisco, USA.
authors: Matthew Z
authors: MZ
authors: Sun
authors: Department of Neurological Surgery, University of California, San Francisco, USA.
authors: Roxanna M
authors: RM
authors: Garcia
authors: Department of Neurological Surgery, University of California, San Francisco, USA.
authors: Michael W
authors: MW
authors: McDermott
authors: Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors: Andrew T
authors: AT
authors: Parsa
authors: Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address: orin.bloch@northwestern.edu.
authors: Orin
authors: O
authors: Bloch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D003399:Craniotomy; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D056888:Patient Positioning; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Complications; Meningioma; Morbidity; Pneumonia; Surgery