Risk factors for postoperative pneumonia following intracranial aneurysm surgery: a propensity score matching analysis

Postoperative pneumonia (POP) after intracranial aneurysm surgery is common and can lead to prolonged hospitalization, respiratory failure, or death, significantly worsening patient outcomes. This study aimed to identify independent preoperative, intraoperative, and postoperative risk factors for POP in patients undergoing intracranial aneurysm surgery using propensity score matching to control for confounding. This retrospective cohort study included 1,115 patients aged ≥ 18 years who underwent intracranial aneurysm surgery at a hospital between January 2019 and July 2022. Patients were grouped by the presence or absence of POP. Logistic regression analysis with 1:1 propensity score matching (PSM) was performed to identify independent risk factors for POP in patients with intracranial aneurysms. After 1:1 propensity score matching, 668 patients (334 per group) were analyzed. Multivariate logistic regression identified six independent risk factors for POP: preoperative antimicrobial prophylaxis, operative duration ≥ 4 h, indwelling gastric tube, intensive care unit (ICU) admission on the day of surgery, postoperative use of analgesics or sedatives, and white blood cell (WBC) count ≥ 10,000 cells/µL. Six risk factors for POP after intracranial aneurysm surgery were identified in this study, some of which are modifiable. Targeting these factors may reduce POP. These variables may inform risk stratification; some may represent potential targets for intervention; however, prospective validation is required before any changes to clinical pathways can be recommended.