Development and validation of a nomogram predicting postoperative pneumonia after major abdominal surgery

  • Keishi Kawasaki
  • Mariko Yamamoto
  • Yusuke Suka
  • Yohei Kawasaki
  • Kyoji Ito
  • Daisuke Koike
  • Takatoshi Furuya
  • Motoki Nagai
  • Yukihiro Nomura
  • Nobutaka TanakaEmail author
  • Yoshikuni KawaguchiEmail author
Original Article



Postoperative pneumonia (POP) is a common complication that can adversely affect the outcomes after surgery. This study aimed to devise and validate a model for stratifying the probability of POP in patients undergoing abdominal surgery.


We included 1050 patients who underwent major abdominal surgery between 2012 and 2013. A nomogram was devised by evaluating the predictive factors for POP.


Of the 1050 patients, 56 (5.3%) developed POP. Multivariable logistic regression analysis revealed that the independent predictive factors for POP were age, male sex, history of cerebrovascular disease, Brinkman Index (BI) ≥ 900, and upper midline incision. A nomogram was devised by employing these five significant predictive factors. The prediction model showed a relatively good discrimination performance, with a concordance index of 0.77.


A nomogram based on age, male sex, history of cerebrovascular disease, BI ≥ 900, and upper midline incision may be useful for identifying patients with a high probability of developing POP after major abdominal surgery.


Postoperative pneumonia Major abdominal surgery Upper midline incision Predictive factor 



Postoperative pneumonia


Brinkman Index


Intensive care unit


Postoperative day


Performance status


Cerebral infarction


The American society of anesthesiologists physical status classification system


Prognostic nutritional index


Interquartile ranges


Odds ratios


Confidence intervals


Body mass index




Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Keishi Kawasaki
    • 1
    • 2
  • Mariko Yamamoto
    • 1
  • Yusuke Suka
    • 1
  • Yohei Kawasaki
    • 3
  • Kyoji Ito
    • 1
    • 4
  • Daisuke Koike
    • 1
  • Takatoshi Furuya
    • 1
  • Motoki Nagai
    • 1
  • Yukihiro Nomura
    • 1
  • Nobutaka Tanaka
    • 1
    Email author
  • Yoshikuni Kawaguchi
    • 1
    • 4
    Email author
  1. 1.Department of SurgeryAsahi General HospitalChibaJapan
  2. 2.Department of General Surgery, Graduate School of MedicineChiba UniversityChibaJapan
  3. 3.Biostatistics Section, Clinical Research CenterChiba University HospitalChibaJapan
  4. 4.Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan

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