ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurocritical and Neurohospitalist Care
This article is part of the Research TopicData Science in Anesthesiology and Intensive CareView all 6 articles
Association between anesthetics and the postoperative pneumonia risk in patients with non-traumatic subarachnoid hemorrhage: an analysis of the MIMIC-IV database
Provisionally accepted
- 1Xinchang County People's Hospital, Xinchang, China
- 2Zhuji Central Hospital, Zhuji, China
- 3Shengzhou Maternal and Child Health Hospital, Shaoxing, China
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Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
Keywords: anesthetic, Fentanyl, Postoperative pneumonia, Non-traumatic subarachnoid hemorrhage, Mimic
Received: 22 Apr 2025; Accepted: 15 Dec 2025.
Copyright: © 2025 Wang, He and Guo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fu Guo
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