A Hiroshima University study of more than 31,000 patients found that pneumonia occurred more frequently after breathing tubes were removed than during mechanical ventilation, with most cases occurring within one to two weeks after surgery. This finding suggests that this underrecognized condition may be a distinct clinical entity associated with swallowing dysfunction and that early assessment and intervention, including identification of high-risk patients, may be key to prevention and improved outcomes.
Pneumonia that develops after endotracheal tube removal can have a significant impact on recovery and quality of life. Ventilators to assist with breathing are a common life-saving procedure during both emergency and elective surgery under general anesthesia, but some patients experience difficulty swallowing after extubation. This can cause aspiration if food or liquid enters the respiratory tract, causing pneumonia and requiring treatment with antibiotics.
In this study, conducted at Hiroshima University Hospital in Hiroshima City, Junko Hirayama, assistant nurse, Masahiro Nakamori, lecturer at the Graduate School of Biomedical and Health Sciences, and colleagues investigated the incidence of post-extubation pneumonia (PEP) in non-emergency surgeries, identified characteristics of high-risk patients, and compared PEP with ventilator-associated pneumonia (VAP) that develops while on a ventilator.
The researchers analyzed records from 2016 to 2023 and found that 212 patients (0.67%) developed pneumonia after breathing tube removal, compared to 27 patients with VAP. Researchers identified PEP as a distinct clinical entity rather than a routine postoperative complication. This paper was published on March 16th. scientific report.
Age, gender, and BMI are risk factors
Patients who developed PEP tended to be older than those who did not. Men had a 65% higher risk than women, but patients with low BMI (BMI <18.5) and those with impaired consciousness were also at significantly higher risk.
The likelihood of pneumonia is increased in a wide range of surgeries, including head and neck surgery, as well as gastrointestinal, respiratory, cardiovascular, and orthopedic surgery, suggesting that the risk of PEP should be recognized in all types of surgery.
Possibility of prevention
This study highlights the impact of PEP on postoperative recovery and quality of life.
Of particular concern was that these patients had originally been admitted to the hospital with hopes of improving through surgery, but their health conditions had deteriorated due to complications. ”
Junko Hirayama, Associate Chief Nursing Officer, Hiroshima University Hospital
Dr. Nakamori emphasized that PEP may be preventable.
“We believe that early assessment and intervention focused on swallowing function by a multidisciplinary team including physicians, dentists, nurses, pharmacists, dietitians, dental hygienists, and rehabilitation specialists is essential to improve clinical outcomes,” he said.
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Reference magazines:
Hirayama, J., others. (2026). Risk factors for post-extubation pneumonia using diagnostic procedure combinations and claims data in Japan. scientific report. DOI: 10.1038/s41598-026-44666-3. https://www.nature.com/articles/s41598-026-44666-3
