Objective To explore the risk factors and preventive strategies of postoperative pneumonia in patients undergoing craniotomy. Methods Medical records of patients who underwent craniotomy in the neurosurgery department of a large teaching hospital from January 2014 to December 2015 were surveyed retrospectively. The survey included general information, surgical conditions, and occurrence of postoperative pneumonia. Risk factors for pneumonia after craniotomy were analyzed. Results A total of 880 patients undergoing craniotomy were investigated, 178 patients (20.23%) had pneumonia after craniotomy. Univariate analysis showed that incidences of pneumonia were higher in patients with older age, preoperative complications of underlying diseases, ASA grade Ⅲ-IV, large blood loss, long duration of operation, long length of hospital stay before operation, intraoperative blood transfusion, indwelling gastric tube, mechanical ventilation time ≥ 4 hours, tracheotomy, and emergency surgery, difference were all significant (all P<0.05). Unconditional multivariate logistic regression analysis showed that six variables were independent risk factors for postoperative pneumonia. The OR from high to low were as follows:tracheotomy (OR, 27.73[95%CI, 2.49-30.83]), postoperative indwelling gastric tube (OR, 4.55[95%CI, 2.54-8.16]), emergency surgery (OR, 4.34[95%CI, 1.49-12.63]), mechanical ventilation time (OR, 2.81[95%CI, 1.37-5.75]), preoperative hospitalization time (OR, 1.06[95%CI, 1.02-1.10]), and age (OR,1.03[95%CI, 1.01-1.04]). Conclusion Incidence of postoperative pneumonia in patients undergoing craniotomy is high, effective prevention and control measures should be taken to reduce the incidence of infection according to risk factors.