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Risk Assessment for Postoperative Pneumonia in Children Living With Neurologic Impairments
Christian Mpody1, Seth Hayes2, Nathan Rusin2
1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio Christian.Mpody@nationwidechildrens.org.
Insights
Children with neurologic comorbidities face nearly double the risk of developing pneumonia after surgery. This highlights the need for targeted research and preventive measures to improve outcomes for these vulnerable pediatric patients.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Neurology
Background:
- Neurologic comorbidities significantly impact pediatric hospitalizations, accounting for a substantial portion of charges.
- Children with these conditions are at increased risk for lower respiratory infections due to impaired physiological functions.
- Evaluating the specific risk of pneumonia in this population is crucial for improving surgical outcomes.
Purpose of the Study:
- To assess the risk of postoperative pneumonia in children with preoperative neurologic comorbidities.
- To quantify the association between neurologic conditions and the incidence of pneumonia within 30 days of surgery.
Main Methods:
- A retrospective analysis of pediatric patients (<18 years) undergoing inpatient surgery from 2012 to 2018.
- Data sourced from the National Surgical Quality Improvement Program.
- Primary outcome: time to incident pneumonia post-surgery.
Main Results:
- The study identified 349,163 children, with a 0.6% incidence of pneumonia within 30 days.
- Neurologic comorbidities were associated with a nearly twofold higher risk of postoperative pneumonia (HR: 1.91).
- Specific conditions like cerebral palsy, seizure disorder, and neuromuscular disorders showed significantly elevated risks.
Conclusions:
- Children with neurologic comorbidities have a substantially increased risk of developing pneumonia after surgery.
- These findings emphasize the necessity for developing targeted preventive strategies and further research.
- Reducing the excess pneumonia risk in this population is critical for improving pediatric surgical care.
Background:
Approximately one-third of all pediatric hospital charges are attributable to the care for children living with neurologic comorbidities. These children often require various surgical procedures and may have an elevated risk of lower respiratory infections because of poor neuromuscular coordination, poor cough, uncoordinated swallowing, and poor oral hygiene. Our objective was to evaluate the risk of pneumonia in children presenting with neurologic comorbidities.
Methods:
We performed a retrospective study of children (<18 years) who underwent inpatient surgery between 2012 and 2018 in hospitals participating in the National Surgical Quality Improvement Program. Our primary outcome was the time to incident pneumonia within the 30 days after surgery.
Results:
We identified 349 163 children, of whom 2191 developed pneumonia (30-day cumulative incidence: 0.6%). The presence of a preoperative neurologic comorbidity conferred approximately twofold higher risk of postoperative pneumonia (hazard ratio [HR]: 1.91, 95% confidence interval [CI]: 1.73-2.11). We explored the risk of pneumonia conferred by the components of neurologic comorbidity: cerebral palsy (HR: 3.92, 95% CI: 3.38-4.56), seizure disorder (HR: 2.93, 95% CI: 2.60-3.30), neuromuscular disorder (HR: 2.63, 95% CI: 2.32-2.99). The presence of a neurologic comorbidity was associated with a longer length of hospital stay (incidence rate ratio: 1.26, 95% CI: 1.25-1.28).
Conclusions:
The risk of postoperative pneumonia was almost twofold higher in children with neurologic comorbidity. The magnitude of these associations underscores the need to identify areas of research and preventive strategies to reduce the excess risk of pneumonia in children with preoperative neurologic conditions.
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