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Effect of Influenza Vaccination Against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: A Nationwide Matched Study.

Abstract

Background

Limited information is available on the association between influenza vaccination and postoperative outcomes.

Methods

Using Taiwan's National Health Insurance Research Database reimbursement claims data from 2008-2013, we conducted a matched cohort study of 16903 patients aged >66 years who received influenza vaccinations and later underwent major surgery. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 16903 controls who underwent surgery but were not vaccinated were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative pneumonia and in-hospital mortality associated with influenza vaccination.

Results

Patients who received preoperative influenza vaccination had a lower risk of postoperative pneumonia (OR, 0.60; 95% CI, .56-.64) and in-hospital mortality (OR, 0.46; 95% CI, .39-.56), compared with unvaccinated patients, in both sexes and every age group. Vaccinated patients who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR, 0.56; 95% CI, .53-.60), shorter hospital stays (P < .0001), and lower medical expenditures (P < .0001) than nonvaccinated controls.

Conclusions

Vaccinated geriatric patients who underwent surgery had lower risks of pneumonia and in-hospital mortality, compared with unvaccinated patients who underwent similar major surgeries. Further studies are needed to explain how preoperative influenza vaccination improves perioperative outcomes.

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  • Authors+Show Affiliations

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    Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taiwan. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.

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    Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Department of Anesthesiology, Taipei Medical University Hospital, Taiwan. Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taiwan.

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    Department of Surgery, China Medical University Hospital, Taichung, Taiwan. Department of Surgery, University of Illinois, Chicago.

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    Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taiwan. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.

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    Divisions of Infectious Diseases, Taipei Medical University Hospital, Taiwan.

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    Divisions of Pulmonary Medicine, Taipei Medical University Hospital, Taiwan. Department of Internal Medicine, Taipei Medical University Hospital, Taiwan.

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    Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taiwan. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.

    ,

    Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Department of Anesthesiology, Taipei Medical University Hospital, Taiwan. Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taiwan.

    Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taiwan. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Department of Anesthesiology, Taipei Medical University Hospital, Taiwan. Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taiwan. School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.

    Source

    The Journal of infectious diseases 217:5 2018 02 14 pg 816-826

    MeSH

    Aged
    Aged, 80 and over
    Cohort Studies
    Critical Care
    Female
    Health Expenditures
    Humans
    Influenza Vaccines
    Influenza, Human
    Length of Stay
    Male
    Pneumonia
    Postoperative Complications
    Risk Assessment
    Taiwan

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    29216345

    Citation

    Liu, Wan-Chi, et al. "Effect of Influenza Vaccination Against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: a Nationwide Matched Study." The Journal of Infectious Diseases, vol. 217, no. 5, 2018, pp. 816-826.
    Liu WC, Lin CS, Yeh CC, et al. Effect of Influenza Vaccination Against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: A Nationwide Matched Study. J Infect Dis. 2018;217(5):816-826.
    Liu, W. C., Lin, C. S., Yeh, C. C., Wu, H. Y., Lee, Y. J., Chung, C. L., ... Liao, C. C. (2018). Effect of Influenza Vaccination Against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: A Nationwide Matched Study. The Journal of Infectious Diseases, 217(5), pp. 816-826. doi:10.1093/infdis/jix616.
    Liu WC, et al. Effect of Influenza Vaccination Against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: a Nationwide Matched Study. J Infect Dis. 2018 02 14;217(5):816-826. PubMed PMID: 29216345.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of Influenza Vaccination Against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: A Nationwide Matched Study. AU - Liu,Wan-Chi, AU - Lin,Chao-Shun, AU - Yeh,Chun-Chieh, AU - Wu,Hsin-Yun, AU - Lee,Yuarn-Jang, AU - Chung,Chi-Li, AU - Cherng,Yih-Giun, AU - Chen,Ta-Liang, AU - Liao,Chien-Chang, PY - 2017/07/18/received PY - 2017/11/29/accepted PY - 2017/12/8/pubmed PY - 2019/4/13/medline PY - 2017/12/8/entrez KW - Influenza vaccination KW - mortality KW - pneumonia KW - surgery SP - 816 EP - 826 JF - The Journal of infectious diseases JO - J. Infect. Dis. VL - 217 IS - 5 N2 - Background: Limited information is available on the association between influenza vaccination and postoperative outcomes. Methods: Using Taiwan's National Health Insurance Research Database reimbursement claims data from 2008-2013, we conducted a matched cohort study of 16903 patients aged >66 years who received influenza vaccinations and later underwent major surgery. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 16903 controls who underwent surgery but were not vaccinated were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative pneumonia and in-hospital mortality associated with influenza vaccination. Results: Patients who received preoperative influenza vaccination had a lower risk of postoperative pneumonia (OR, 0.60; 95% CI, .56-.64) and in-hospital mortality (OR, 0.46; 95% CI, .39-.56), compared with unvaccinated patients, in both sexes and every age group. Vaccinated patients who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR, 0.56; 95% CI, .53-.60), shorter hospital stays (P < .0001), and lower medical expenditures (P < .0001) than nonvaccinated controls. Conclusions: Vaccinated geriatric patients who underwent surgery had lower risks of pneumonia and in-hospital mortality, compared with unvaccinated patients who underwent similar major surgeries. Further studies are needed to explain how preoperative influenza vaccination improves perioperative outcomes. SN - 1537-6613 UR - https://www.unboundmedicine.com/medline/citation/29216345/Effect_of_Influenza_Vaccination_Against_Postoperative_Pneumonia_and_Mortality_for_Geriatric_Patients_Receiving_Major_Surgery:_A_Nationwide_Matched_Study_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jix616 DB - PRIME DP - Unbound Medicine ER -