title: Incidence and risk factors for pneumonia following anterior cervical decompression and fusion procedures: an ACS-NSQIP study.
abstract: BACKGROUND
  Postoperative pneumonia has important clinical consequences for both patients and the health-care system. Few studies have examined pneumonia following anterior cervical decompression and fusion (ACDF) procedures.
  
  
  OBJECTIVE
  This study aimed to determine the incidence and risk factors for development of pneumonia following ACDF procedures.
  
  
  METHODS
  A retrospective cohort study of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program was carried out.
  
  
  METHODS
  This study comprised 11,353 patients undergoing ACDF procedures during 2011-2013.
  
  
  METHODS
  The primary outcome was diagnosis of pneumonia in the first 30 postoperative days.
  
  
  METHODS
  Independent risk factors for the development of pneumonia were identified using multivariate regression. Readmission rates were compared between patients who did and did not develop pneumonia using multivariate regression that adjusted for all demographic, comorbidity, and procedural characteristics.
  
  
  RESULTS
  The incidence of pneumonia was 0.45% (95% confidence interval=0.33%-0.57%). In the multivariate analysis, independent risk factors for the development of pneumonia were greater age (p<.001), dependent functional status (relative risk [RR]=5.3, p<.001), chronic obstructive pulmonary disease (RR=4.4, p<.001), and greater operative duration (p=.020). Patients who developed pneumonia following discharge had a higher readmission rate than other patients (72.7% vs. 2.4%, adjusted RR=24.5, p<.001). In total, 10.2% of all readmissions were caused by pneumonia.
  
  
  CONCLUSIONS
  Pneumonia occurs in approximately 1 in 200 patients following ACDF procedures. Patients who are older, are functionally dependent, or have chronic obstructive pulmonary disease are at greater risk. These patients should be counseled, monitored, and targeted with preventative interventions accordingly. Greater operative duration is also an independent risk factor. Approximately three in four patients who develop pneumonia following hospitalization for ACDF procedures are readmitted. This elevated readmission rate has implications for bundled payments and hospital performance reports.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT 06510, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA.
authors.forename: Junyoung
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Rossi
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Tabaraee
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT 06510, USA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA. Electronic address: kern.singh@rushortho.com.
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D015897:Comorbidity; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D058996:Quality Improvement; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000379:methods*; D055815:Young Adult
keywords: Age; Anterior cervical decompression and fusion; Chronic obstructive pulmonary disease; Functional status; Mortality; Operative duration; Postoperative pneumonia; Readmission