# Association between anesthetics and the postoperative pneumonia risk in patients with non-traumatic subarachnoid hemorrhage: an analysis of the MIMIC-IV database

## TL;DR

This study found that fentanyl is a strong predictor of postoperative pneumonia risk in patients with non-traumatic subarachnoid hemorrhage.

## Contribution

The study identifies fentanyl as an independent predictor of postoperative pneumonia in non-traumatic SAH patients using the MIMIC-IV database.

## Key findings

- Fentanyl showed higher predictive value than propofol, midazolam, and dexmedetomidine for postoperative pneumonia.
- Fentanyl remained significantly associated with postoperative pneumonia after adjusting for confounders.
- Fentanyl improved the predictive efficacy of traditional disease severity scores.

## Abstract

Postoperative pneumonia (POP) is a common complication in surgical patients. The choice of anesthetic may affect POP in patients with non-traumatic subarachnoid hemorrhage (SAH). This study aims to identify a key anesthetic as an independent predictor for POP risk in patients with non-traumatic SAH.

This retrospective study utilized data from the MIMIC-IV database spanning the period from 2008 to 2019. First, receiver operating characteristic (ROC) curve analysis, decision curve analysis, and factor importance analysis were conducted to determine which anesthetic was more effective and important in predicting POP in patients with non-traumatic SAH. Second, three different multivariate logistic regression models were established to investigate the association between fentanyl use and the risk of POP, followed by subgroup analysis. Finally, a series of comparative analyses were conducted between fentanyl and traditional disease severity scores.

Fentanyl (AUC: 0.680) demonstrated a significantly higher predictive value than propofol (AUC: 0.604), midazolam (AUC: 0.608), and dexmedetomidine (AUC: 0.630) in predicting POP in patients with non-traumatic SAH (all Delong test p < 0.05). Multivariate logistic regression analysis revealed that fentanyl remained significantly associated with POP after adjustment for various confounders (Model 1: OR = 4.979, 95%CI: 3.652–6.874; Model 2: OR = 2.965, 95%CI: 2.138–4.152; Model 3: OR = 4.433, 95%CI: 3.239–4.152). CHF and CVD significantly modified the association of fentanyl with POP. Further, fentanyl demonstrated satisfactory clinical value and increased the predictive efficacy of the traditional disease severity scores.

Our findings indicated that fentanyl was associated with POP and may serve as a robust predictor of POP risk in patients with non-traumatic SAH.