Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-23T13:14:31.361Z Has data issue: false hasContentIssue false
  • English
  • Français

Temporal trends in postoperative and ventilator-associated pneumonia in the United States

Published online by Cambridge University Press:  03 November 2022

Mark L. Metersky Open the ORCID record for Mark L. Metersky [Opens in a new window] ,
Yun Wang ,
Michael Klompas ,
Sheila Eckenrode ,
Jasie Mathew Open the ORCID record for Jasie Mathew [Opens in a new window]  and
Harlan M. Krumholz Open the ORCID record for Harlan M. Krumholz [Opens in a new window]
Mark L. Metersky*
Affiliation:
Division of Pulmonary, Critical Care Medicine and Sleep Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
Yun Wang
Affiliation:
Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Sheila Eckenrode
Affiliation:
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
Jasie Mathew
Affiliation:
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
Harlan M. Krumholz
Affiliation:
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
*
Author for correspondence: Mark L. Metersky, E-mail: metersky@uchc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine change in rates of postoperative pneumonia and ventilator-associated pneumonia among patients hospitalized in the United States during 2009–2019.

Design:

Retrospective cohort study.

Patients:

Patients hospitalized for major surgical procedures, acute myocardial infarction, heart failure, and pneumonia.

Methods:

We conducted a retrospective review of data from the Medicare Patient Safety Monitoring System, a chart-abstraction–derived database including 21 adverse-event measures among patients hospitalized in the United States. Changes in observed and risk-adjusted rates of postoperative pneumonia and ventilator-associated pneumonia were derived.

Results:

Among 58,618 patients undergoing major surgical procedures between 2009 and 2019, the observed rate of postoperative pneumonia from 2009–2011 was 1.9% and decreased to 1.3% during 2017–2019. The adjusted annual risk each year, compared to the prior year, was 0.94 (95% CI, 0.92–0.96). Among 4,007 patients hospitalized for any of these 4 conditions at risk for ventilator-associated pneumonia during 2009–2019, we did not detect a significant change in observed or adjusted rates. Observed rates clustered around 10%, and adjusted annual risk compared to the prior year was 0.99 (95% CI, 0.95–1.02).

Conclusions:

During 2009–2019, the rate of postoperative pneumonia decreased statistically and clinically significantly in among patients hospitalized for major surgical procedures in the United States, but rates of ventilator-associated pneumonia among patients hospitalized for major surgical procedures, acute myocardial infarction, heart failure, and pneumonia did not change.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 8 , August 2023 , pp. 1247 - 1254
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of healthcare-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Walter, J, Haller, S, Quinten, C, et al. Healthcare-associated pneumonia in acute-care hospitals in European Union/European Economic Area countries: an analysis of data from a point prevalence survey, 2011 to 2012. Euro Surveill. 2018; 23.Google ScholarPubMed
Chughtai, M, Gwam, CU, Khlopas, A, et al. The incidence of postoperative pneumonia in various surgical subspecialties: a dual database analysis. Surg Technol Int 2017;30:45–51.Google ScholarPubMed
Metersky, ML, Wang, Y, Klompas, M, et al. Trend in ventilator-associated pneumonia rates between 2005 and 2013. JAMA 2016;316:2427–2429.10.1001/jama.2016.16226CrossRefGoogle ScholarPubMed
Papazian, L, Klompas, M, Luyt, CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med 2020;46:888–906.CrossRefGoogle ScholarPubMed
Kalil, AC, Metersky, ML, Klompas, M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63:e61–e111.CrossRefGoogle Scholar
Kazaure, HS, Martin, M, Yoon, JK, et al. Long-term results of a postoperative pneumonia prevention program for the inpatient surgical ward. JAMA Surg 2014;149:914–918.10.1001/jamasurg.2014.1216CrossRefGoogle ScholarPubMed
Ventilator-associated pneumonia. Institute for Healthcare Improvement website. http://www.ihi.org/Topics/VAP/Pages/default.aspx. Accessed May 10, 2021.Google Scholar
Klompas, M, Anderson, D, Trick, W, et al. The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med 2015;191:292–301.10.1164/rccm.201407-1394OCCrossRefGoogle ScholarPubMed
Dudeck, MA, Edwards, JR, Allen-Bridson, K, et al. National Healthcare Safety Network report, data summary for 2013, device-associated module. Am J Infect Control 2015;43:206–221.10.1016/j.ajic.2014.11.014CrossRefGoogle ScholarPubMed
Klompas, M. Eight initiatives that misleadingly lower ventilator-associated pneumonia rates. Am J Infect Control 2012;40:408–410.10.1016/j.ajic.2011.07.012CrossRefGoogle ScholarPubMed
Cassidy, MR, Rosenkranz, P, McCabe, K, et al. I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program. JAMA Surg 2013;148:740–745.CrossRefGoogle ScholarPubMed
Caparelli, ML, Shikhman, A, Jalal, A, et al. Prevention of postoperative pneumonia in noncardiac surgical patients: a prospective study using the national surgical quality improvement program database. Am Surg 2019;85:8–14.10.1177/000313481908500104CrossRefGoogle ScholarPubMed
Wren, SM, Martin, M, Yoon, JK, et al. Postoperative pneumonia-prevention program for the inpatient surgical ward. J Am Coll Surg 2010;210:491–495.CrossRefGoogle ScholarPubMed
Hunt, DR VN, Abend, SL, Lyder, C, Jaser, LJ, Safer, N, Davern, P. Fundamentals of Medicare patient safety surveillance: intent, relevance and transparency. In: Henrikson, K et al, editors. Advances in Patient Safety: From Research to Implementation, Vol 2, Concepts and Methodology. Rockville, MD: Agency for Healthcare Research and Quality; 2005.Google Scholar
Metersky, ML, Eldridge, N, Wang, Y, et al. Predictors of warfarin-associated adverse events in hospitalized patients: opportunities to prevent patient harm. J Hosp Med 2016;11:276–282.CrossRefGoogle ScholarPubMed
Eckenrode, S, Bakullari, A, Metersky, ML, et al. The association between age, sex, and hospital-acquired infection rates: results from the 2009–2011 National Medicare Patient Safety Monitoring System. Infect Control Hosp Epidemiol 2014;35 suppl 3:S3–S9.CrossRefGoogle Scholar
Bakullari, A, Metersky, ML, Wang, Y, et al. Racial and ethnic disparities in healthcare-associated infections in the United States, 2009–2011. Infect Control Hosp Epidemiol 2014;35 suppl 3:S10–S16.10.1086/677827CrossRefGoogle Scholar
Metersky, ML, Eldridge, N, Wang, Y, et al. National trends in the frequency of bladder catheterization and physician-diagnosed catheter-associated urinary tract infections: results from the Medicare Patient Safety Monitoring System. Am J Infect Control 2017;45:901–904.CrossRefGoogle ScholarPubMed
Classen, DC, Munier, W, Verzier, N, et al. Measuring patient safety: the medicare patient safety monitoring system (past, present, and future). J Patient Saf 2021;17:e234–e240.10.1097/PTS.0000000000000322CrossRefGoogle ScholarPubMed
Wang, Y, Eldridge, N, Metersky, ML, et al. National trends in patient safety for four common conditions, 2005–2011. N Engl J Med 2014;370:341–351.CrossRefGoogle ScholarPubMed
Wang, Y, Eldridge, N, Metersky, ML, et al. Association between hospital performance on patient safety and 30-day mortality and unplanned readmission for Medicare fee-for-service patients with acute myocardial infarction. J Am Heart Assoc 2016;5:e003731.CrossRefGoogle ScholarPubMed
Elixhauser, A SC, Palmer, L. Clinical Classifications Software (CCS). US Agency for Healthcare Research and Quality website. http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed January 16, 2020.Google Scholar
Moore, BJ, White, S, Washington, R, et al. Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: the AHRQ Elixhauser comorbidity index. Med Care 2017;55:698–705.10.1097/MLR.0000000000000735CrossRefGoogle ScholarPubMed
von Elm, E, Altman, DG, Egger, M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007;4:e296.CrossRefGoogle ScholarPubMed
Kneuertz, PJ, Singer, E, D’Souza, DM, et al. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: a propensity score-weighted comparison. J Thorac Cardiovasc Surg 2019;157:2018–2026.CrossRefGoogle ScholarPubMed
Oshikiri, T, Yasuda, T, Kawasaki, K, et al. Hand-assisted laparoscopic surgery (HALS) is associated with less-restrictive ventilatory impairment and less risk for pulmonary complication than open laparotomy in thoracoscopic esophagectomy. Surgery 2016;159:459–466.10.1016/j.surg.2015.07.026CrossRefGoogle ScholarPubMed
Masoomi, H, Buchberg, B, Nguyen, B, et al. Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis. World J Surg 2011;35:2143–2148.CrossRefGoogle ScholarPubMed
Matsutani, N, Dejima, H, Nakayama, T, et al. Impact of pregabalin on early phase postthoracotomy pain compared with epidural analgesia. J Thorac Dis 2017;9:3766–3773.CrossRefGoogle ScholarPubMed
Li, W, Li, Y, Huang, Q, et al. Short and long-term outcomes of epidural or intravenous analgesia after esophagectomy: a propensity-matched cohort study. PLoS One 2016;11:e0154380.10.1371/journal.pone.0154380CrossRefGoogle ScholarPubMed
Wang, C, Lai, Y, Li, P, et al. Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1,749 cases. BMC Surg 2021;21:115.CrossRefGoogle Scholar
Rozario, D. A systems approach to the management of acute surgical pain and reduction of opioid use: the approach of Oakville Trafalgar Memorial Hospital. Can J Surg 2020;63:E606–E608.CrossRefGoogle Scholar
Dublin, S, Walker, RL, Jackson, ML, et al. Use of opioids or benzodiazepines and risk of pneumonia in older adults: a population-based case-control study. J Am Geriatr Soc 2011;59:1899–1907.CrossRefGoogle ScholarPubMed
Thompson, MP, Cabrera, L, Strobel, RJ, et al. Association between postoperative pneumonia and 90-day episode payments and outcomes among medicare beneficiaries undergoing cardiac surgery. Circ Cardiovasc Qual Outcomes 2018;11:e004818.10.1161/CIRCOUTCOMES.118.004818CrossRefGoogle ScholarPubMed
Vazquez Guillamet, C, Kollef, MH. Is Zero Ventilator-associated pneumonia achievable? Practical approaches to ventilator-associated pneumonia prevention. Clin Chest Med 2018;39:809–822.CrossRefGoogle ScholarPubMed
Campogiani, L, Tejada, S, Ferreira-Coimbra, J, et al. Evidence supporting recommendations from international guidelines on treatment, diagnosis, and prevention of HAP and VAP in adults. Eur J Clin Microbiol Infect Dis 2020;39:483–491.10.1007/s10096-019-03748-zCrossRefGoogle ScholarPubMed
O’Grady, NP, Murray, PR, Ames, N. Preventing ventilator-associated pneumonia: does the evidence support the practice? JAMA 2012;307:2534–2539.CrossRefGoogle ScholarPubMed
Klompas, M. Prevention of intensive care unit-acquired pneumonia. Semin Respir Crit Care Med 2019;40:548–557.Google ScholarPubMed
Santacruz, CA, Pereira, AJ, Celis, E, et al. Which multicenter randomized controlled trials in critical care medicine have shown reduced mortality? A systematic review. Crit Care Med 2019;47:1680–1691.CrossRefGoogle ScholarPubMed
Supplementary material: File

Metersky et al. supplementary material

Table S1

Download Metersky et al. supplementary material(File)
File 16.5 KB