Epidemiology of Postoperative Pneumonia in Pediatric Inpatient Surgery: An ACS NSQIP-P Analysis

Postoperative pneumonia (POP) is a serious surgical complication associated with increased morbidity, mortality, and health care costs. Although well described in adult surgical populations, the epidemiology of POP in children remains less clearly defined. Our objective was to characterize the epidemiology of POP among children undergoing inpatient surgery and identify patient- and procedure-level factors associated with POP.

We performed a retrospective analysis of pediatric inpatient noncardiac surgical cases captured in the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-P) from 2012 to 2022. The primary outcome was POP within 30 days, defined using standardized NSQIP-P criteria. POP was summarized as a proportion of surgical cases and described by surgical specialty, age group, and calendar year. To evaluate independent associations, multivariable logistic regression models were constructed adjusting for relevant demographic and clinical covariates.

Among 673 547 inpatient surgical cases, 4191 (0.6%) were complicated by POP. Higher odds of POP were observed among children with higher American Society of Anesthesiologists (ASA) physical status classifications (adjusted odds ratio [aOR], 4.63; 95% CI, 4.21-5.09), ventilator dependence (aOR, 1.97; 95% CI, 1.80-2.16), chronic lung disease (aOR, 1.68; 95% CI, 1.54-1.82), airway abnormalities (aOR, 1.56; 95% CI, 1.44-1.69), and recent corticosteroid exposure (aOR, 1.38; 95% CI, 1.25-1.53). POP risk differed across surgical specialties, with otolaryngologic procedures associated with higher odds of POP compared with general surgery (aOR, 1.46; 95% CI, 1.32-1.62).

In this national analysis, POP was uncommon but disproportionately affected medically complex children. Observed variation across surgical specialties highlights important epidemiologic patterns that may inform future hypothesis-driven studies focused on mechanisms and prevention.