Neurologic comorbidity increases risk for postoperative pneumonia in children
Children with a neurologic comorbidity experienced an almost twofold greater risk for postoperative pneumonia, according to results from a retrospective study published in Pediatrics.
“Children living with neurologic comorbidities (a heterogeneous group of static and/or progressive disorders involving the central nervous system) represent a group with disproportionately high use of emergency health care services and higher rates of hospitalizations and readmissions,” the researchers wrote. “Approximately one-third of all pediatric hospital charges (amount billed to patients or payers for service provided) are attributable to the care for children with neurologic comorbidities.”
Additionally, recent estimates have shown that an increasing number of children who are hospitalized have a neurologic comorbidity. As a result, more children who undergo surgical procedures may have a comorbid neurological diagnosis, according to the researchers.
Christian Mpody, MD, PhD, MPH, MBA, of the department of anesthesiology and pain medicine at Nationwide Children’s Hospital in Ohio, and colleagues aimed to determine the risk for pneumonia among children who presented with neurologic comorbidities. The researchers undertook a retrospective study of children aged younger than 18 years who had inpatient surgery between 2012 and 2018 in hospitals participating in the National Surgical Quality Improvement Program. Time to incident pneumonia within 30 days of surgery served as the primary outcome.
The researchers identified 349,163 children (median age, 7 years) who had surgery during the study period, more than half of whom were boys (54.5%) and most of whom were white (67.1%). Emergent or urgent surgery occurred in 34% of children and general surgery represented the most common surgery specialty, accounting for 47.7% of the study cohort, according to the researchers.
Over the course of the study, 2,191 children developed pneumonia, for a 30-day cumulative incidence of 0.6%. Mpody and colleagues found that a preoperative neurologic comorbidity resulted in an estimated twofold greater risk for postoperative pneumonia (HR = 1.91; 95% CI, 1.73-2.11).
The researchers also examined the risk for pneumonia as “conferred by the components of neurologic comorbidity,” including cerebral palsy (HR = 3.92; 95% CI, 3.38-4.56), seizure disorder (HR = 2.93; 95% CI, 2.6-3.3) and neuromuscular disorder (HR = 2.63; 95% CI, 2.32-2.99). The presence of a neurologic comorbidity correlated with a longer hospital length of stay (incidence RR = 1.26; 95% CI, 1.25-1.28).
An E value analysis demonstrated that the results from Mpody and colleagues “were robust to unmeasured confounding.” According to the researchers, the results “have major clinical importance” for several reasons. These reasons included the “dual challenge” of surgical rehabilitation and recovery from pneumonia and its complications, all in children with preoperative neurological impairment who are “especially vulnerable.” Additionally, the number of children with neurological impairments are continually increasing, Mpody and colleagues noted, which means that strategies for “targeted and coordinated perioperative care” are needed to address the needs of this growing population.
“Although children with cerebral palsy appear to have the greatest risk of postoperative pneumonia, other neurologic disorders were also associated with elevated risk,” the researchers wrote. “Therefore, when caring for children with neurologic comorbidities, perioperative care should focus on measures to reduce the occurrence of postsurgical pneumonia.”