Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy.
Pancreatectomy is associated with a high complication rate that varies between 40-60%. Although many specific complications have been extensively studied, postoperative pneumonia has received little attention.



Patients undergoing pancreaticoduodenectomy (n = 1,090) and distal pancreatectomy (n = 436) from 2002 to 2014 at Thomas Jefferson University Hospital were retrospectively assessed for postoperative pneumonia. Incidence, predictive factors, and outcomes were determined.



Pneumonia was diagnosed in 4.3% of patients after pancreaticoduodenectomy and 2.5% after distal pancreatectomy. The majority of the pneumonias were attributed to aspiration (87.2% and 81.8%, respectively). Pneumonias were more frequently severe (Clavien-Dindo grades 4 or 5) in the pancreaticoduodenectomy group compared to the distal pancreatectomy group (55.3% vs 9.1%, P = .006). Post-pancreaticoduodenectomy pneumonia predictors included delayed gastric emptying (odds ratio 8.2, P < .001), oxygen requirement on postoperative day 3 (odds ratio 3.2, P = .005), and chronic obstructive pulmonary disease (odds ratio 3.1, P = .049). In the post-pancreaticoduodenectomy group, pneumonia was associated with a very high 90-day mortality compared with those who did not have pneumonia (29.8% vs 2.1%, P < .001) and had the largest effect on mortality after pancreaticoduodenectomy (odds ratio 9.6, P < .001). A preoperative risk score model for pneumonia post-pancreaticoduodenectomy was developed.



Pneumonia after pancreaticoduodenectomy is an uncommon but highly morbid event and is associated with a substantially increased risk of perioperative death.
Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Ramzy T
RT
Nagle
Department of Biostatistics, The Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Benjamin E
BE
Leiby
Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Harish
H
Lavu
Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Ernest L
EL
Rosato
Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Charles J
CJ
Yeo
Department of Surgery, The Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA. Electronic address: Jordan.winter@jefferson.edu.
Jordan M
JM
Winter
D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011014:Pneumonia / Q000401:mortality* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome