Pneumonia After Surgery

Why is Pneumonia More Common After Surgery?

Surgery Often Requires the Use of a Ventilator.

What is Pneumonia 

Pneumonia is an infection of the lungs that can range from mild to life-threatening.  It is a condition where the lungs become inflamed and the alveoli (air sacs) in the lungs bein to fill with pus.  The condition usually causes coughing, fever and chills, difficulty breathing, shortness of breath and the patient may have difficulty with ordinary activities due to an inability to supply the body with enough oxygen.

 

Surgery and Pneumonia

Patients who have recently had surgery are at a higher risk for pneumonia, for multiple reasons.  Being intubated and placed on a ventilator, which happens during general anesthesia, increases the risk of pneumonia by placing a foreign object in the airway.  Intubation also increases the risk of aspiration, a condition caused by breathing stomach contents into the lungs.  

Patients who have recently had surgery may also be experiencing significant pain, which makes them unwilling to cough, they key way to prevent pneumonia.  Simple activities like walking several times a day can also help prevent pneumonia, surgery patients who are unable to get out of bed will also have higher rates of pneumonia. 

Types of Pneumonia

There are multiple types of pneumonia, which are typically categorized by where the condition started. The three most commonly treated types of pneumonia are:

Community Acquired Pneumonia: This is pneumonia that an individual contracts outside of the hospital or healthcare setting.  For most individuals, this means you were living in your home at the time you became ill.  You contracted pneumonia from a bacteria or virus that you were exposed to while outside of a healthcare facility.

 

The exception to this is individuals who live in a long term care facility, commonly referred to as a nursing home.  An individual who contracts pneumonia while living in one of these facilities who is diagnosed with pneumonia is diagnosed with healthcare associated pneumonia.

Healthcare Acquired Pneumonia (HAP or HCAP): This is pneumonia that was likely to have started with bacteria or a virus from a healthcare facility.  Individuals who receive hemodialysis, who live in a long term nursing facility, have been hospitalized 2 or more days in the last 90 days, or have received IV chemotherapy or antibiotics in the last 30 days will be diagnosed with healthcare acquired pneumonia.

Ventilator Acquired Pneumonia (VAP): This type of pneumonia is diagnosed after the patient has been on a ventilator at least 48 hours. 

Why Does It Matter Where I Got Pneumonia?

Pneumonia is treated based on where it was contracted because the germs that cause pneumonia are typically different inside a healthcare facility and in the community.

  Pneumonia can be caused by bacteria, a virus, a fungus or even parasites. Research has shown that different antibiotics should be used for these different types of bacterial pneumonias, for the best possible outcome. 

For the hospital, the correct diagnosis means widely differing reimbursements from Medicare, Medicaid and insurance companies.  Most of these companies will not reimburse a hospital for the added days of care (which can be significant) caused by pneumonia acquired within their facility.  This has added great incentive for hospitals to make progress in the prevention of pneumonia, which in turn benefits patients tremendously.

Source:

Pneumonia. National Heart Lung and Blood Institute. Accessed April, 2015. http://www.nhlbi.nih.gov/health/health-topics/topics/pnu

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