PRISMA 2020 Checklist

This systematic review and meta-analysis aimed to evaluate the incidence and perioperative risk factors for postoperative infectious pneumonia (PIP) in adult patients undergoing cardiothoracic surgery, including CABG, heart valve procedures, and thoracic oncologic surgeries. Following PRISMA 2020 guidelines, the authors conducted a rigorous search across PubMed, Embase, and Scopus for cohort studies published between January 2021 and December 2023. From 1,142 initial records, 6 high-quality cohort studies (totaling 4,392 patients) were included in the final analysis. The pooled incidence of PIP was 14.8% (95% CI: 10.6%–19.2%), with the highest rates observed after thoracic oncologic surgeries (17.2%). The most significant risk factors for PIP included: Prolonged mechanical ventilation >48 hours (OR: 3.46) Advanced age >70 years (OR: 2.71) Chronic obstructive pulmonary disease (COPD) (OR: 2.95) Extended cardiopulmonary bypass (CPB) time >120 minutes (OR: 2.63) Reduced left ventricular ejection fraction (<40%) (OR: 2.38) Statistical heterogeneity was moderate (I² = 46%), and no significant publication bias was detected. The study concludes that PIP is a frequent and serious complication after cardiothoracic surgery. Targeted preventive strategies—such as early extubation, lung-protective ventilation, and preoperative pulmonary optimization—are urgently needed to reduce the burden of this condition and improve surgical outcomes.