Objective  To clarify the incidence and risk factors of postoperative pulmonary infection in patients undergoing craniotomy, and to provide a basis for early identification and prevention of postoperative pulmonary infection.

Methods  The literature related to the incidence and risk factors of postoperative pulmonary infection in patients undergoing craniotomy was searched from January 1, 2014, to September 3, 2025, in domestic and foreign databases. Meta- analysis was performed using Stata 18 software.

Results  A total of 26 articles were included, with a total sample size of 64,568 cases, 3,619 positive cases, and the incidence of postoperative pulmonary infection was 29.6% [95%CI (24.8%, 34.4%)]. Among them, increasing age, age≥60 years, age≥70 years, smoking history, male, GCS score<8 points, preoperative hyperglycemia, emergency surgery, intraoperative bleeding, intraoperative blood loss>50 mL, intraoperative blood transfusion, second operation, operation duration≥3 hours, tracheostomy, mechanical ventilation, mechanical ventilation duration≥7days, mechanical ventilation duration≥14days, the use antimicrobial drugs,  bed rest time>14 days, ICU admission>7 days, diabetes mellitus, tumors located lateral to the brainstem and at the base of the skull,  high Hunt grade were risk factors for postoperative lung infection in patients undergoing craniotomy (P<0.05).

Conclusion  Based on the above risk factors, clinical practice can identify the patients with a high incidence of postoperative lung infection in the early stage and take targeted measures in time to improve the prognosis of  patients.

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