Postoperative Pneumonia Risk in Children With Neurologic and Neuromuscular Disorders.

Background And Objectives: Children with neurologic and neuromuscular complex chronic conditions (NNCCCs) undergo various procedures to optimize their health. We assessed the prevalence, characteristics, and risk of postoperative pneumonia (PoP) across surgery types, hospitals, and comorbidities in children with NNCCC.

Methods: This study is a retrospective analysis of 63 732 inpatient surgical encounters (2016-2020) in 45 freestanding children's hospitals for patients of any age with NNCCCs in the Pediatric Health Information System database. NNCCCs were distinguished with International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes using Feudtner's system. PoP within 7 days of surgery was identified with International Classification of Diseases, 10th Revision, Clinical Modification codes with antibiotic exposure (coded documentation of antibiotics being given). PoP likelihood was assessed by type of procedure across hospitals and by clinical characteristics using Rao-Scott χ2 tests and estimating equations.

Results: The prevalence of 7-day PoP was 1.1% (n = 688), with significant variation (P < .001) across hospitals (range: 0.4% to 3.0%). The highest PoP rates were found for bone marrow transplant (12.5%), solid organ transplantation (8.1%), and cardiothoracic surgery (4.5%); the lowest PoP rates included craniofacial/plastic (0.8%) and neurology (0.3%). Patients with ≥4 coexisting chronic conditions had the highest likelihood of acquiring PoP (odds ratio 10.69 [95% confidence interval 6.62-17.25]).

Conclusions: PoP in children with NNCCCs varied significantly across hospitals and types of surgery. Further investigation is needed to assess how to ameliorate the risk of PoP in children with NNCCCs, especially those with multimorbidity.