Prevalence and risk factors for ventilator-associated pneumonia after cardiac surgery: a systematic review and meta-analysis

There is currently significant variation in the reported incidence of ventilator-associated pneumonia (VAP) among postoperative cardiac patients. Moreover, the risk factors for VAP in postoperative cardiac patients remain controversial. This study aims to assess the incidence and risk factors of VAP in postoperative cardiac patients to provide a basis for further prevention and treatment of VAP. We systematically reviewed PubMed, EMBASE, and Cochrane Library databases to select studies that met the inclusion criteria until November 2023. Fifteen studies involving 10,478 patients who underwent cardiac surgery were selected for meta-analysis. The incidence of VAP in postoperative cardiac patients was 10%. The preoperative risk factors for VAP after cardiac surgery included age >70 years, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, renal disease, and severe pulmonary hypertension. Furthermore, the perioperative risk factors for VAP after cardiac surgery included emergency surgery, redo surgery, airway instrumentation, gastric aspiration, reintubation, mechanical ventilation duration >3 days, intra-aortic balloon, New York Heart Association >3, American Society of Anesthesiologists >3, need for transfusion during surgery, and ascending aortic surgery. The incidence of VAP after cardiac surgery was found to be 10%, and the comprehensive risk factors for VAP were identified, emphasizing the critical need for targeted interventions, including optimization of preoperative health and refined surgical protocols, to effectively reduce the occurrence of VAP in postoperative cardiac patients.