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Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity
Kwaku Owusu-Bediako1, Christian Mpody1,2, Christopher Iobst3
1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Childhood obesity appears to reduce the risk of postoperative pneumonia in children with neurologic disorders, contrary to expectations. This suggests an "obesity paradox" warrants further investigation in pediatric surgical patients.
Area of Science:
- Pediatric Surgery
- Neurology
- Pulmonary Medicine
Background:
- Postoperative pneumonia is a significant complication, increasing mortality risk in children.
- Neuromuscular impairments and obesity are known risk factors for postoperative pulmonary complications.
- The interplay between obesity and postoperative pneumonia risk in children with neurologic diseases is not well understood.
Purpose of the Study:
- To investigate the association between obesity status and the risk of postoperative pneumonia in children with neurologic disorders undergoing orthopedic surgery.
Main Methods:
- Retrospective cohort analysis of children (≤18 years) from the National Surgical Quality Improvement Program (2012-2019) database.
- Cox proportional regression models were used to assess the association between neurologic disorders and postoperative pneumonia, including an interaction term for body mass index.
- Stratified analyses were performed across body mass index subgroups.
Main Results:
- The study included 60,745 children, with 30.8% classified as overweight/obese.
- Children with neurologic disorders had a higher incidence of postoperative pneumonia compared to those without.
- The association between neurologic disorders and pneumonia was strongest in overweight children (Hazard Ratio: 11.88) compared to healthy weight (3.55) or obese (9.45) children.
Conclusions:
- Childhood obesity appears to buffer the risk of postoperative pneumonia in children with neurologic disorders, suggesting an "obesity paradox."
- Further research is needed to elucidate the mechanisms behind this observed obesity paradox in this vulnerable pediatric population.
Introduction:
Postoperative pneumonia increases the risk of postsurgical mortality, making it a serious healthcare-associated complication. Children with preoperative neuromuscular impairments have a higher risk of postoperative pneumonia. Obesity is also a risk factor for postoperative pulmonary complications, including pneumonia. Moreover, obesity is increasingly prevalent among children living with a neurological diagnosis. Whether obesity increases the risk of postoperative pneumonia among children with neurologic diseases remains largely unknown. Therefore, we assessed the risk of postoperative pneumonia among children with neurologic diagnoses based on their obesity status.
Methods:
We analyzed a retrospective cohort of children ≤18 years from the National Surgical Quality Improvement Program (2012-2019) database who underwent inpatient orthopedic surgery. We used Cox proportional regression model to estimate the hazard ratio for the association between neurologic disorders and postoperative pneumonia. In addition, we included an interaction term between body mass index and neurologic disorders to evaluate the moderating effect of obesity status and then performed stratified analyses to compare the magnitude of hazard ratios across body mass index subgroups.
Results:
A total of 60 745 children underwent inpatient orthopedic surgery during the study period, of whom 43.6% were healthy weight and 30.8% overweight/obese. The median age was 13 years (Interquartile range: 8-15). The incidence of postoperative pneumonia was higher among healthy weight patients with neurologic disorders than healthy weight patients without any neurologic disorders [Hazard ratio: 3.55 vs. 0.34]. Furthermore, the association between neurologic disorders and postoperative pneumonia was strongest among overweight patients than healthy weight or obese patients [Hazard ratio:11.88 vs. 9.45 vs. 4.40]. This observation was consistent across the various neurologic disorders analyzed.
Conclusion:
Childhood obesity buffered the association between neurologic disorders and postoperative pneumonia, consistent with an 'obesity paradox'. Further research exploring the underlying mechanisms for the obesity paradox in children with neurologic disorders is warranted.
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