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Original Investigation | Pacific Coast Surgical Association

Long-term Results of a Postoperative Pneumonia Prevention Program for the Inpatient Surgical Ward

Hadiza S. Kazaure, MD1; Molinda Martin, BSN, RN2; Jung K. Yoon, RN, MS2; Sherry M. Wren, MD1,2
[+] Author Affiliations
1Department of General Surgery, Stanford University School of Medicine, Stanford, California
2Veterans Affairs Palo Alto Health Care System, Palo Alto, California
JAMA Surg. 2014;149(9):914-918. doi:10.1001/jamasurg.2014.1216.
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Importance  Pneumonia is the third most common complication in postoperative patients and is associated with significant morbidity and high cost of care. Prevention has focused primarily on mechanically ventilated patients. This study outlines the results of the longest-running postoperative pneumonia prevention program for nonmechanically ventilated patients, to our knowledge.

Objective  To present long-term results (2008-2012) of a standardized postoperative ward-acquired pneumonia prevention program introduced in 2007 on the surgical ward of our hospital and compare our postintervention pneumonia rates with those captured in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). We also estimate the cost savings attributable to the pneumonia prevention program.

Design, Setting, and Participants  Retrospective cohort study at a university-affiliated Veterans Affairs hospital of all noncardiac surgical patients with ward-acquired postoperative pneumonia.

Intervention  A previously described standardized postoperative pneumonia prevention program for patients on the surgical ward.

Main Outcome and Measure  Ward-acquired postoperative pneumonia.

Results  Between 2008 and 2012, there were 18 cases of postoperative pneumonia among 4099 at-risk patients hospitalized on the surgical ward, yielding a case rate of 0.44%. This represents a 43.6% decrease from our preintervention rate (0.78%) (P = .01). The pneumonia rates in all years were lower than the preintervention rate (0.25%, 0.50%, 0.58%, 0.68%, and 0.13% in 2008-2012, respectively). The overall pneumonia rate in ACS-NSQIP was 2.56% (14 033 cases of pneumonia among 547 571 at-risk patients), which is 582% higher than the postintervention rate at our ward. Using a national average of $46 400 in attributable health care cost of postoperative pneumonia and a benchmark of a 43.6% decrease in pneumonia rate achieved at our facility over the 5-year study period, a similar percentage of decrease in pneumonia occurrence at ACS-NSQIP hospitals would represent approximately 6118 prevented pneumonia cases and a cost savings of more than $280 million.

Conclusions and Relevance  The standardized pneumonia prevention program achieved substantial and sustained reduction in postoperative pneumonia incidence on our surgical ward; its wider adoption could improve postoperative outcomes and reduce overall health care costs.

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