Table 3.
Surgical approach, perioperative management, inflammatory response, and postoperative recovery characteristics of the study cohort stratified by postoperative pneumonia status.
| Characteristic | Overall | (n = 467) | Postoperative pneumonia | P-value | |SMD| | |
|---|---|---|---|---|---|
| No | (n = 320) | Yes | (n = 147) | ||||
| Surgical approach and intraoperative characteristics | |||||
| Surgical approach | 0.677 | 0.088 | |||
| MIE McKeown | 371 (79.4%) | 257 (80.3%) | 114 (77.6%) | ||
| Hybrid McKeown | 56 (12.0%) | 38 (11.9%) | 18 (12.2%) | ||
| Open McKeown | 40 (8.6%) | 25 (7.8%) | 15 (10.2%) | ||
| Thoracic access | 0.157 | 0.192 | |||
| Thoracoscopic | 403 (86.3%) | 279 (87.2%) | 124 (84.4%) | ||
| Open thoracotomy | 60 (12.8%) | 40 (12.5%) | 20 (13.6%) | ||
| Converted open thoracotomy | 4 (0.9%) | 1 (0.3%) | 3 (2.0%) | ||
| Abdominal access | 0.418 | 0.132 | |||
| Laparoscopic | 385 (82.4%) | 267 (83.4%) | 118 (80.3%) | ||
| Open laparotomy | 76 (16.3%) | 48 (15.0%) | 28 (19.0%) | ||
| Converted open laparotomy | 6 (1.3%) | 5 (1.6%) | 1 (0.7%) | ||
| Conversion to open, yes | 14 (3.0%) | 8 (2.5%) | 6 (4.1%) | 0.386 | 0.093 |
| Operative duration (min) | 275.73 ± 42.34 | 272.35 ± 40.50 | 283.09 ± 45.35 | 0.015 | 0.25 |
| Single-lung ventilation time (min) | 151.02 ± 44.15 | 150.73 ± 45.67 | 151.66 ± 40.76 | 0.826 | 0.021 |
| Intraoperative blood loss (mL) | 124.36 ± 55.02 | 122.43 ± 52.86 | 128.57 ± 59.42 | 0.285 | 0.109 |
| Recurrent laryngeal nerve injury, yes | 27 (5.8%) | 21 (6.6%) | 6 (4.1%) | 0.286 | 0.106 |
| Postoperative respiratory and ICU management | |||||
| Extubated in OR/PACU, yes | 283 (60.6%) | 198 (61.9%) | 85 (57.8%) | 0.405 | 0.083 |
| Time to extubation (hours) | 3.2 (1.8–13.7) | 3.0 (1.8–12.5) | 3.4 (1.8–16.6) | 0.122 | 0.235 |
| Prolonged ventilation ≥ 24 h, yes | 37 (7.9%) | 18 (5.6%) | 19 (12.9%) | 0.007 | 0.27 |
| Reintubation, yes | 17 (3.6%) | 4 (1.2%) | 13 (8.8%) | <0.001 | 0.405 |
| Initial ICU stay (days) | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 0.349 | 0.095 |
| ICU readmission, yes | 27 (5.8%) | 4 (1.2%) | 23 (15.6%) | <0.001 | 0.617 |
| Cumulative ICU stay (days) | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | <0.001 | 0.398 |
| Nutritional support and postoperative diet | |||||
| Enteral access | 0.186 | 0.219 | |||
| Jejunostomy tube | 334 (71.5%) | 232 (72.5%) | 102 (69.4%) | ||
| Nasojejunal tube | 100 (21.4%) | 70 (21.9%) | 30 (20.4%) | ||
| Oral only/no feeding tube | 23 (4.9%) | 11 (3.4%) | 12 (8.2%) | ||
| No early enteral access | 10 (2.1%) | 7 (2.2%) | 3 (2.0%) | ||
| Parenteral nutrition, yes | 63 (13.5%) | 25 (7.8%) | 38 (25.9%) | <0.001 | 0.528 |
| Supplemental PN duration among PN users (days) | 6.0 (5.0–8.0) | 6.0 (5.0–8.0) | 7.0 (5.2–8.0) | 0.215 | 0.291 |
| Enteral nutrition start (POD) | 1.0 (1.0–1.0) | 1.0 (1.0–2.0) | 1.0 (1.0–1.0) | <0.001 | 0.39 |
| Oral liquid start (POD) | 7.0 (7.0–9.0) | 7.0 (6.0–8.0) | 9.0 (8.0–11.0) | <0.001 | 1.124 |
| Soft diet start (POD) | 11.0 (10.0–13.0) | 11.0 (9.0–12.0) | 13.0 (12.0–15.0) | <0.001 | 0.909 |
| Respiratory rehabilitation and mobilization | |||||
| Respiratory rehabilitation start (POD) | 1.0 (0.0–1.0) | 1.0 (0.0–1.0) | 1.0 (1.0–1.0) | 0.021 | 0.235 |
| Respiratory rehabilitation on POD0-1, yes | 421 (90.1%) | 294 (91.9%) | 127 (86.4%) | 0.065 | 0.184 |
| First ambulation (POD) | 1.0 (1.0–2.0) | 1.0 (1.0–2.0) | 2.0 (1.0–2.0) | 0.008 | 0.26 |
| Ambulation within POD1, yes | 253 (54.2%) | 183 (57.2%) | 70 (47.6%) | 0.054 | 0.192 |
| Perioperative steroid exposure | |||||
| Dexamethasone for PONV, yes | 235 (50.3%) | 166 (51.9%) | 69 (46.9%) | 0.322 | 0.099 |
| Prophylactic high-dose steroid, yes | 12 (2.6%) | 8 (2.5%) | 4 (2.7%) | 1.000 | 0.014 |
| Therapeutic postoperative steroid, yes | 31 (6.6%) | 12 (3.8%) | 19 (12.9%) | <0.001 | 0.369 |
| Any steroid before pneumonia/POD3, yes | 239 (51.2%) | 169 (52.8%) | 70 (47.6%) | 0.297 | 0.104 |
| Perioperative inflammatory response | |||||
| Preoperative CRP (mg/L) | 4.7 (3.5–6.3) | 4.5 (3.4–5.8) | 5.5 (3.8–7.2) | <0.001 | 0.504 |
| CRP on POD1 (mg/L) | 87.1 (68.8–102.8) | 87.2 (69.3–102.7) | 86.8 (68.5–103.7) | 0.792 | 0.03 |
| CRP on POD3 (mg/L) | 130.3 (110.8–153.4) | 124.6 (106.3–144.2) | 151.4 (122.1–172.2) | <0.001 | 0.689 |
| CRP on POD5 (mg/L) | 90.1 (69.2–120.0) | 78.2 (61.9–98.5) | 126.3 (102.8–151.3) | <0.001 | 1.334 |
| CRP on POD7 (mg/L) | 63.3 (41.6–89.2) | 52.0 (37.8–69.7) | 98.7 (71.2–126.3) | <0.001 | 1.231 |
| Peak CRP on POD0-7 (mg/L) | 137.6 (118.2–159.5) | 127.7 (113.2–146.3) | 160.4 (138.5–179.6) | <0.001 | 1.078 |
| SIRS duration on POD0-30 (days) | 1.0 (0.0–2.0) | 1.0 (0.0–1.0) | 2.0 (2.0–3.0) | <0.001 | 1.29 |
| SIRS ≥ 48 h, yes | 196 (42.0%) | 75 (23.4%) | 121 (82.3%) | <0.001 | 1.193 |
| Fever duration (days) | 1.0 (0.0–2.0) | 1.0 (0.0–2.0) | 3.0 (1.0–4.0) | <0.001 | 1.227 |
Data are presented as mean ± standard deviation, median (interquartile range), or n (%), as appropriate. Normally distributed intraoperative continuous variables were compared using Welch’s t-test; skewed time-to-event, ICU, nutritional, rehabilitation, and inflammatory variables were compared using the Mann–Whitney U test. Categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Absolute standardized mean differences (|SMD|) were calculated to quantify between-group imbalance. Supplemental PN duration was summarized among patients who received parenteral nutrition (overall n = 63; no-pneumonia n = 25; pneumonia n = 38). Enteral nutrition start was summarized among patients with available early enteral nutrition data (overall n = 457; no-pneumonia n = 313; pneumonia n = 144).