Risk Assessment for Postoperative Pneumonia in Children Living With Neurologic Impairments

The Effect of Laboratory Parameters on the Hospital Stay and Mortality in Pediatric Patients Who Underwent Lobectomy and Pneumonectomy

Background and Objectives: This study aims to evaluate the prognostic significance of various laboratory parameters in predicting the length of hospital stay and mortality among pediatric patients undergoing lobectomy and pneumonectomy for infectious or noninfectious diseases. Materials and Methods: This study was conducted by retrospective data analysis of 59 pediatric patients who underwent lobectomy and pneumonectomy due to variable diseases at the department of chest surgery. Pediatric patients diagnosed with variable diseases and who underwent lobectomy or pneumonectomy, patients who were hospitalized during the study period and underwent surgical intervention, and patients who had at least one laboratory parameter recorded before surgery were included in the study. Laboratory parameters included white blood cell (WBC) count, red cell distribution width (RDW), platelet (PLT) count, neutrophil count, mean platelet volume (MPV), monocyte count and lymphocyte count. Laboratory results were obtained from the patients' most recent blood samples before surgery. In addition, derived ratios such as platelet-to-lymphocyte ratio (PLR), MPV-to-PLT ratio (MPR), MPV-to-monocyte ratio (MMR), MPV-to-lymphocyte ratio (MPVLR), monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR), and Pan-Immune-Inflammation Value (PIV) were calculated and their potential prognostic values were evaluated. Results: The mean age of the patients was 6.3 years (0-15 years). The gender distribution of the patients in the study group was determined as 36 male patients (61%) and 23 female patients (39%). Lobectomy was the most commonly performed surgical procedure, accounting for 83% of cases, while pneumonectomy was applied in 17% of cases. The postoperative complication rate was observed as 34%. The mean hospital stay of the patients was calculated as 12.61 days (2-84 days), while the mortality rate was recorded as 8.5%. The relationship between the neutrophil count and the length of hospital stay is quite strong, and the r value was calculated as 0.550 (p < 0.01). PIV showed a strong correlation with length of hospital stay, with an r value of 0.650 (p < 0.01). A significant relationship was also found between PLR and length of hospital stay (r = 0.500, p < 0.01). The parameters with the highest positive effect on the hospital stay are neutrophil count (B = 0.400, p < 0.01) and PIV (B = 0.500, p < 0.01). The mean hospital stay was 10.00 days (2-30) in patients without complications and 15.00 days (5-40) in patients with complications, and this difference was also significant (p < 0.01). Finally, the mortality rate was 2.5% in patients without complications, while it was determined as 20% in those with complications (p < 0.01). Conclusions: This study determines the effects of laboratory parameters (particularly PIV, neutrophil, PLR, and NLR) on the duration of hospital stay, development of complications, and mortality and emphasizes the importance of monitoring these parameters in the treatment of infectious or noninfectious diseases.

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.

Failure to rescue following postoperative pneumonia in pediatrics: Is there a racial disparity?

INTRODUCTION

Racial disparities in measures of health and healthcare processes are well described. Limited work exists on disparities in failure to rescue - hospital mortality following a major adverse event. Postoperative pneumonia is a serious, potentially preventable adverse event that often leads to death, i.e., failure to rescue. This study examined the association of racial grouping with failure to rescue following postoperative pneumonia.

METHODS

We utilized the National Surgical Quality Improvement Program-Pediatrics Participant Use Data File to assemble a cohort of children <18 years who underwent inpatient surgery from 2012 to 2022. We included Black and White patients who developed pneumonia following an index surgery. The primary outcome was failure to rescue, defined as mortality following postoperative pneumonia. We used logistic regression models to estimate the odds ratio and 95% confidence intervals of failure to rescue, comparing Black and White children.

RESULTS

The study cohort included 3139 children <18 years who developed pneumonia following inpatient surgery. Of those, 2333 (74.3%) were White and 806 (25.7%) were Black. Failure to rescue occurred in 117 of the children (3.7%); 82 were White (3.5%) and 35 were Black (4.3%). After adjusting for gender, age, American Society of Anesthesiologists Physical Status classification, emergent/urgent vs. elective case status, year of operation, and pre-existing comorbidities, the odds of failure to rescue for Black children with postoperative pneumonia did not differ from White children (adjusted-Odds Ratio: 1.00; 95% Confidence Interval 0.62-1.61; p-value = .992).

CONCLUSION

We found no significant difference in the odds of failure to rescue following postoperative pneumonia between Black or White children. To improve postoperative care for all children and to narrow the racial gap in postoperative mortality, future studies should continue to investigate the association of race with failure to rescue following other postoperative complications.

Understanding and managing respiratory infections in children and young adults with neurological impairment

INTRODUCTION

Patients with neurocognitive impairment (NI) have multiple medical needs, with respiratory problems leading to an important reduction in quality of life and life expectancy. We aimed to explain that the origin of chronic respiratory symptoms in patients with NI is multifactorial.

AREAS COVERED

In people with NI there is a high prevalence of swallowing dysfunction and hypersalivation inducing aspiration; cough efficacy is decreased resulting in chronic lung infection; sleep-disordered breathing is frequent and muscle mass is abnormal due to malnutrition. Technical investigations are not always specific and sensitive enough to better diagnose the causes of the respiratory symptoms; moreover, they can sometimes be difficult to perform in this vulnerable patient population. We provide a clinical pathway to adopt to identify, prevent, and treat respiratory complications in children and young adults with NI. A holistic approach in discussion with all care providers and the parents is highly recommended.

EXPERT OPINION

The care for people with NI and chronic respiratory problems is challenging. The interplay between several causative factors may be difficult to entangle. Well-performed clinical research in this field is largely missing and should be encouraged. Only then, evidence-based clinical care will become possible for this vulnerable patient group.

Pneumonia after hip surgery in children with neurological complex chronic conditions

AIM

In children with neurological complex chronic conditions (CCC) undergoing hip surgery we aimed to: estimate the rate of postoperative pneumonia, determine the effect of pneumonia on postoperative hospital resource use, and identify predictors of postoperative pneumonia.

METHOD

A retrospective cohort study was conducted utilizing the Pediatric Health Information System database for 2609 children (1081 females, 1528 males) aged 4 years and older with a neurological CCC who underwent hip surgery (i.e. reconstruction surgery or salvage procedure) between 2016 and 2018 in 41 US children's hospitals. Multivariable, mixed-effects logistic regression was used to assess patient characteristics and risk of pneumonia.

RESULTS

Mean age at hip surgery was 10 years 1 month (SD 4y 8mo). The postoperative pneumonia rate was 1.6% (n=42). Median length of stay (LOS) was longer for children with pneumonia and the 30-day all-cause unplanned readmission rate and costs were higher. Variability in rates of pneumonia ranged from 1.1% to 2.8% across hospitals. Significant predictors of postoperative pneumonia were osteotomy type (p=0.005) and number of chronic conditions (p≤0.001).

INTERPRETATION

Postoperative pneumonia after hip surgery in children with a neurological CCC is associated with longer LOS, readmissions, and higher costs. Children undergoing pelvic osteotomies and who have multimorbidity need additional clinical support to prevent postoperative pneumonia and decrease resource utilization.

WHAT THIS PAPER ADDS

Pneumonia is a major postoperative complication in children with neurological complex chronic conditions (CCC). Forty-two (1.6%) children with neurological CCC developed pneumonia after hip surgery. Length of stay, readmissions, and costs were significantly higher in the group with pneumonia. Variability in pneumonia rates existed across hospitals. Predictors of developing pneumonia include osteotomy type and number of CCC.

Innovative Techniques Associated with Traditional Abdominal Surgery in Complex Pediatric Cases: A Tertiary Center Experience

Pediatric abdominal surgery is constantly evolving, alongside the advent of new surgical technologies. A combined use of new tools and traditional surgical approaches can be useful in the management of complex cases, allowing less invasive procedures and sometimes even avoiding multiple interventions. This combination of techniques has implications even from the anesthetic point of view, especially in post-operative pain control. Thereby, tertiary level centres, including highly-specialized professionals and advanced equipment, can maximize the effectiveness of treatments to improve the final outcomes. Our paper aims to present some possible combinations of techniques recently used at our institution to provide a one-session, minimally invasive treatment within different areas of abdominal surgery.