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Aspiration pneumonia after antireflux surgery among neurologically impaired children with GERD

John Maret-Ouda1, Giola Santoni2, Miia Artama3

  • 1Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.

Journal of Pediatric Surgery
|February 11, 2020
PubMed

Insights

Fundoplication surgery significantly reduced aspiration pneumonia risk in neurologically impaired children with GERD. While not eliminating the risk, it offers a valuable treatment option for recurrent cases.

Area of Science:

  • Pediatric Gastroenterology
  • Surgical Outcomes
  • Neurology

Background:

  • Aspiration pneumonia is a serious complication of GERD in neurologically impaired children.
  • Medical management of GERD often fails to prevent aspiration pneumonia.
  • The efficacy of antireflux surgery (fundoplication) in preventing aspiration pneumonia is uncertain.

Purpose of the Study:

  • To determine if fundoplication surgery prevents aspiration pneumonia in neurologically impaired children with GERD.
  • To compare the risk of aspiration pneumonia before and after fundoplication.

Main Methods:

  • Population-based cohort study in Denmark, Finland, Norway, and Sweden.
  • Compared preoperative and postoperative person-time for aspiration pneumonia risk.
  • Utilized multivariable Cox regression, adjusting for confounders and clinical factors.

Main Results:

  • Fundoplication was associated with a 56% decrease in the overall hazard ratio for aspiration pneumonia (HR 0.44).
  • The risk reduction for aspiration pneumonia increased over time post-surgery.
  • No significant decrease was observed for other types of pneumonia (HR 0.79).

Conclusions:

  • Antireflux surgery, specifically fundoplication, reduces but does not eliminate aspiration pneumonia risk in this population.
  • Fundoplication is a potential treatment option for recurrent aspiration pneumonia in neurologically impaired children with GERD.
Abstract

Keywords:
FundoplicationGERDGORDPediatric

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