Risk Assessment for Postoperative Pneumonia in Children Living With Neurologic Impairments

Abstract

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.