Unfortunately, pneumonia after surgery is still a big problem in 2020. Too many people are still getting pneumonia after both routine and urgent surgeries. Surgeons have consulted me hundreds of times in the last 15 years to treat hospitalized patients with pneumonia after surgery. Based on my own experience and a review of latest medical literature, I am going to explain some important facts about pneumonia after surgery. I am writing this article especially for patients and families. I will only use plain English and explain all medical terms.
In this article I will explain:
- What causes pneumonia after surgery
- How to quickly recognize signs and symptoms of pneumonia after surgery
- Who has a higher risk of getting pneumonia after surgery
- What the usual timeline of pneumonia is after surgery
- What you can do to prevent pneumonia after surgery
What causes pneumonia after surgery?
There are several things that put you at a higher risk of pneumonia after surgery:
- Aspiration into airways: After surgery, you may breathe food particles, saliva, vomit and other things into your airways. This process is called aspiration in medical terms, and is a major factor that causes pneumonia after surgery.
- Diminished immune response due to stress of surgery and illness
- Collapse of lower parts of the lungs: After surgery you may not take deep enough breaths due to pain or discomfort. The lower parts of your lungs may not expand when you do not take deep breaths. Eventually, the lower parts of your lungs completely collapse. This puts you at a higher risk of getting pneumonia.
- Invasive procedures provide increased opportunity for pneumonia-causing bacteria to invade your body. After surgery, you may need multiple invasive procedures such as IV lines, blood transfusions, tubes down your food pipe, and more. Germs get an opportunity to invade your body and cause pneumonia.
- Presence of drug-resistant germs in the hospital: Hospitals are full of germs that are more resistant to antibiotics than similar germs out in the community. The longer you stay in the hospital, the more you are exposed to these germs. You can get pneumonia after surgery as you are exposed to these germs.
Who is at a higher risk of getting pneumonia after surgery?
You are at a higher risk of getting pneumonia after surgery if any of these apply to you:
- If you are 75 years of age or older, studies have shown that your risk of getting pneumonia after surgery is significantly higher than people that are younger than you. Pneumonia after surgery in elderly patients is not only more common but also has a worse outcome.
- If you have uncontrolled diabetes, you are at a higher risk of getting infections including pneumonia.
- If you have an underlying lung disease such as COPD, your lungs are more vulnerable to getting pneumonia after surgery.
- If you are a smoker, studies have proven that you are at a significantly higher risk of developing all kinds of problems after surgery, including pneumonia.
- If you require a prolonged use of a ventilator after surgery, you are at a higher risk of getting pneumonia after surgery.
- Having a history of alcohol abuse and alcoholism has also been identified as a risk factor for getting pneumonia after surgery.
- If you struggling with cancer or getting chemotherapy for cancer, you are at a higher risk of getting pneumonia after surgery.
- If you were malnourished prior to surgery, you are at a higher risk of getting pneumonia after surgery.
Signs and symptoms of pneumonia after surgery
Signs and symptoms of pneumonia after surgery may not be easy to detect. Sometimes, they are overlooked, and the diagnosis and treatment are delayed, resulting in a worse outcome. Here are some of the signs and symptoms that may be present:
- Fever: A fever may not always be present with pneumonia after surgery. However, it is important to think about pneumonia after surgery if you have a fever. It is important to get a chest x-ray to look for pneumonia if you have a fever within 48 to 72 hours of surgery.
- Cough with thick yellow phlegm
- Worsening confusion and disorientation
- Low oxygen levels
- Shortness of breath
- Shallow and fast breathing
- Abnormal labs
What is the usual timeline of pneumonia after surgery?
Strictly speaking, pneumonia that is diagnosed within 48 to 72 hours of surgery is considered pneumonia related to the surgery. However, this is only the timeline chosen to help researchers follow strict guidelines so that research on pneumonia after surgery can be done with the same standard across different hospitals. In practice, pneumonia after surgery may not always happen in that exact time period. However, if the timing of your pneumonia is way off, your pneumonia may not be related to surgery. For example, I have admitted patients to the hospital with pneumonia 3 weeks after surgery. In such cases, the pneumonia is not necessarily related to the surgery. Anytime you are hospitalized, you are at an increased risk of picking up drug-resistant organisms. If you get pneumonia 3 weeks after surgery, you are at risk of having hospital-acquired bacterial pneumonia, but it is not necessarily related to the surgery.
What you can do to prevent pneumonia after surgery
I will list several things that may prevent or at least reduce the risk of getting pneumonia after surgery. Some of the things in the list are common infection prevention strategies, and others are actually studied in medical research. It is important to understand the general principles to prevent pneumonia after surgery. Some specific things mentioned in the list may not apply to you.
Here is the list:
- Good oral hygiene: If you are being hospitalized for a non-urgent surgery, it is important that your mouth and teeth are clean. If you have any dental infections, you need to get those taken care of. You need to brush and floss your teeth regularly, and use mouthwash if appropriate. If you can reduce the amount of germs in your mouth, you can reduce your risk of getting pneumonia after surgery.
- Deep breathing exercises: It is very important to properly do deep breathing exercises after a surgery to prevent pneumonia. You need to take frequent deep breaths even if it causes pain. They also have devices called incentive spirometers that help you with these deep breathing exercises. Learn to use those properly and ask the nurse to help you master those devices. They can greatly reduce your risk of getting pneumonia after surgery.
- Follow proper coughing techniques: Ask your surgical nurse or your respiratory therapist to teach you the proper way to cough and clear your airways. Coughing is a natural defense mechanism against pneumonia. Do not suppress your cough as that may put you at a higher risk of getting pneumonia after surgery. You need to take a deep breath, briefly hold your breath when your lungs are full, and cough out bodily fluids as you release your breath. This exercise will go a long way to prevent pneumonia after surgery.
- Sitting upright: If you can, you need to sit upright to help your lungs expand naturally and prevent your oral bodily fluids from going down your air pipe.
- Walking early: The earlier you can walk after surgery, the more you can prevent getting pneumonia. Walk as soon as you can after a surgery to help expand your lungs and prevent pneumonia. Walking can also prevent blood clots after surgery.
- Using the right amount of pain medications: It is important to get your pain down to a certain level so that you can participate in breathing exercises and can walk. However, too many pain medications can make you drowsy and more vulnerable to getting bodily fluids down your air pipe. You need the right amount of pain control to prevent pneumonia after surgery.
In conclusion, pneumonia after surgery is a serious health problem. Despite advances in surgical techniques and hospital care, pneumonia after surgery still happens more often than we can afford. It is important to follow preventive measures to decrease your risk of getting pneumonia after surgery, and that requires your active participation. It is also important to pay attention to your symptoms to diagnose pneumonia as soon as possible in order to start treatments and improve the outcome.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412519/
https://clinicaltrials.gov/ct2/show/NCT01446874
https://www.nursingcenter.com/journalarticle?Article_ID=2501188&Journal_ID=606913&Issue_ID=2500979