Preoperative risk factors for postoperative pneumonia in patients with esophageal cancer: A systematic review and meta-analysis.

Postoperative pneumonia is a critical problem after esophagectomy. This systematic review examined overall risk factors for pneumonia after esophagectomy comprehensively and compared their relative impact on patients with esophageal cancer. We searched MEDLINE, Embase, CENTRAL, and Web of Science in November, 2024, and included cohort studies on esophageal neoplasms, esophagectomy, pneumonia, and risk factors in this review. Study quality was assessed with the Newcastle-Ottawa Scale. The search yielded 3,323 records, among which 60 studies were eligible. The mean patient age ranged from 60.3 years to 73.9 years and the pneumonia incidence ranged from 2.0% to 61.5%. Thirty-seven risk factors were reported. By predefined levels of significance, age and smoking status were very strong (≥10 significant studies and >50% of all studies), and sarcopenia, forced expiratory volume (FEV), oral status, and physical frailty were strong (6-9 significant studies and >50% of all studies). Regarding the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework, age, smoking status, sarcopenia, FEV, and physical frailty were rated as having moderate certainty, and oral status was rated as having low certainty. Based on pooled odds ratios (random-effects models) the highest-ranked factors were physical frailty (OR: 5.170, 95% CI: 2.430-11.020), sarcopenia (OR: 2.790, 95% CI: 1.600-4.860), and FEV (OR: 2.730, 95% CI: 1.500-4.960).