The accuracy of hospital acquired pneumonia diagnosis following esophagectomy: a retrospective analysis from a tertiary specialist centre.

Hospital-acquired pneumonia (HAP) is a common and challenging complication following esophagectomy, with definitions that vary widely across clinical and research settings. The Centres for Disease Control and Prevention (CDC) criteria are endorsed by international consensus groups as a reference standard, but their relevance in postoperative surgical populations remains uncertain. This study aimed to assess the diagnostic performance of alternative criteria, including the American Thoracic Society (ATS) guidelines, the Utrecht definition, and the Clinical Pulmonary Infection Score (CPIS), as well as clinical diagnoses made at our center, compared against the CDC definition. We conducted a retrospective review of all consecutive esophagectomies performed at a regional specialist center from 2014-2022. Data included patient demographics, comorbidities, imaging, and postoperative outcomes. The CDC criteria were used as the reference standard for HAP, against which the sensitivity and specificity of the ATS, Utrecht, and CPIS criteria, as well as clinical diagnoses, were evaluated. Among 460 patients, 223 (48.5%) were treated for HAP, but only 56 (12.2%) met CDC criteria. The ATS criteria demonstrated the highest agreement with the CDC definition (sensitivity 97.5%, specificity 92.0%), while the Utrecht and CPIS criteria showed lower specificity. Clinical diagnoses demonstrated high sensitivity (88.9%) but low specificity (50.1%) relative to CDC-defined HAP. The mean time to HAP diagnosis was 5 days (SD ± 3.7), and just over half of treated patients had positive sputum cultures. There is significant variability in HAP diagnosis following esophagectomy depending on which criteria are applied. Clinical diagnoses often exceed formal definitions, suggesting a risk of overdiagnosis and overtreatment. These findings support the need for tailored, consensus-based criteria to improve diagnostic accuracy, guide appropriate treatment, and enhance benchmarking across centers.