POSTOPERATIVE PNEUMONIA AFTER CARDIOTHORACIC SURGERY: WHAT CAN TWO DECADES OF CDC WONDER DATA TELL US?

MIAN ZAHID JAN KAKAKHEL; HASAN Ilyas; ISHTIAQ Ahmad; SHAFIQ UR Rahman; SANIYA Ishtiaq; SAEED AFTAB Khan; MUHAMMAD USMAN Haider; ZARYAB Bacha; ABDULLAH Afridi; MUHAMMAD SIRTAJ Afridi; HAMNA Jawad; MADHO Mal; WASIQUE Mirza

doi:10.1016/j.chest.2025.07.142

PURPOSE: Postoperative pneumonia (POP) is a significant cause of morbidity and mortality following cardiothoracic surgery. This study examines national trends in mortality from POP in the United States between 1999 and 2020. METHODS: Using CDC WONDER data (1999-2000), we identified deaths where pneumonia was a contributing cause after cardiothoracic surgery. Yearly trends were analyzed using Annual Percent Change (APC) and Average Annual Percent Change (AAPC), with statistical significance determined by p-values. RESULTS: From 1999 to 2020, POP mortality significantly increased, rising from 34,756 deaths (age-adjusted rate: 12.8) in 1999 to 124,172 deaths (age-adjusted rate: 30.0) in 2020. Mortality declined slightly from 1999 to 2018 (APC: -0.53%; 95% CI: -1.04 to -0.02), but surged sharply between 2018 and 2020 (APC: 62.72%; 95% CI: 42.20 to 87.19). Overall, from 1999 to 2020, mortality increased significantly (AAPC: 4.23%; 95% CI: 2.29 to 5.56), with 930,918 total deaths, 902,859 of which were in individuals aged 45 or above. From 1999 to 2018, POP mortality declined across all racial and ethnic groups, with the greatest decrease in the Asian or Pacific Islander population (APC: -2.41%; 95% CI: -2.77 to -2.04) and Hispanic or Latino (APC: -1.35%; 95% CI: -1.71 to -0.98). However, from 2018 to 2020, mortality surged, especially in the Hispanic or Latino population (APC: 116.29%; 95% CI: 100.83 to 132.94), followed by American Indian or Alaska Native (APC: 99.41%; 95% CI: 69.20 to 135.01). Over the entire period, the highest overall increase was in the Hispanic or Latino population (AAPC: 6.30%; 95% CI: 5.53 to 7.07), while the lowest was in the Asian or Pacific Islander group (AAPC: 1.93%; 95% CI: 1.14 to 2.72). Between 1999 to 2018, APC rates showed a slight, non-significant decline in mortality in females (-0.29%) and a significant decline in males (-1.08%, 95% CI: -1.66 to -0.48). From 2018 to 2020, both genders saw sharp increases, with females experiencing a 51.27% rise (95% CI: 30.97 to 74.73) and males a 68.08% rise (95% CI: 43.29 to 97.16). Over the entire period, the AAPC was positive for both genders; females (3.74%, 95% CI: 2.36 to 5.15) and males (4.04%, 95% CI: 2.49 to 5.61), indicating an overall upward trend. Regionally, the Northeast and Midwest experienced the highest increases in mortality rates. From 1999 to 2018, the Northeast had a slight increase (APC: 0.66 [95% CI: -0.11 to 1.44]) while other regions saw declines. However, from 2018 to 2020, all regions experienced sharp rises, with the Northeast (APC: 139.12 [95% CI: 107.40 to 175.69]) and Midwest (APC: 137.47 [95% CI: 89.49 to 197.61]) showing the highest increases. Over the entire period (1999-2020), the Northeast had the highest average annual percent change (AAPC: 9.30 [95% CI: 7.76 to 10.86]), while the West had the lowest (AAPC: 5.14 [95% CI: 4.08 to 6.20]) CONCLUSIONS: POP mortality after cardiothoracic surgery increased significantly, especially from 2018-2020, disproportionately affecting vulnerable populations and specific geographic regions. CLINICAL IMPLICATIONS: Enhanced perioperative care, early pneumonia detection, and targeted interventions are crucial to reducing disparities and improving outcomes for high-risk patients.

POSTOPERATIVE PNEUMONIA AFTER CARDIOTHORACIC SURGERY: WHAT CAN TWO DECADES OF CDC WONDER DATA TELL US?

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