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Pneumonia after hip surgery in children with neurological complex chronic conditions

Rachel L Difazio1,2, Benjamin J Shore1,2, Patrice Melvin3

  • 1Division of Orthopedic Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA, USA.

Developmental Medicine and Child Neurology
|July 11, 2022
PubMed

Insights

Postoperative pneumonia is a significant risk for children with neurological complex chronic conditions (CCC) undergoing hip surgery, leading to increased hospital stays and costs. Identifying predictors like osteotomy type and number of chronic conditions is crucial for prevention.

Area of Science:

  • Pediatric Surgery
  • Critical Care Medicine
  • Health Services Research

Background:

  • Children with neurological complex chronic conditions (CCC) face significant risks during major orthopedic procedures.
  • Postoperative pneumonia is a serious complication impacting recovery and resource utilization in this vulnerable population.

Purpose of the Study:

  • To estimate the incidence of postoperative pneumonia in children with neurological CCC undergoing hip surgery.
  • To determine the impact of pneumonia on hospital resource use (length of stay, readmissions, costs).
  • To identify predictors of postoperative pneumonia in this cohort.

Main Methods:

  • Retrospective cohort study using the Pediatric Health Information System database (2016-2018).
  • Included 2609 children aged 4+ with neurological CCC undergoing hip surgery across 41 US children's hospitals.
  • Multivariable, mixed-effects logistic regression analyzed patient characteristics and pneumonia risk.

Main Results:

  • The postoperative pneumonia rate was 1.6% (42/2609 children).
  • Pneumonia was associated with significantly longer length of stay, higher 30-day readmission rates, and increased costs.
  • Predictors included osteotomy type (p=0.005) and number of chronic conditions (p≤0.001).
  • Pneumonia rates varied across hospitals (1.1% to 2.8%).

Conclusions:

  • Postoperative pneumonia significantly increases hospital resource utilization in children with neurological CCC after hip surgery.
  • Children undergoing pelvic osteotomies and those with multiple chronic conditions require targeted clinical support to mitigate pneumonia risk.
  • Strategies to prevent pneumonia are essential for improving outcomes and reducing healthcare costs in this population.
Abstract

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