Association of childhood asthma with postoperative pneumonia.
Bronchial asthma is one of the most prevalent chronic childhood diseases worldwide. It is known that a diagnosis of bronchial asthma increases the risk of invasive pneumonia in the general population. In this study the authors wished to investigate whether children with a diagnosis of bronchial asthma were at an increased risk of pneumonia in the postoperative setting compared to those without asthma.
The American database, the National Surgical Quality Improvement Program, was used to identify a cohort of children who underwent inpatient surgery between 2012-2015 at multiple centres across the United States. Of the 93061 cases identified, 7237 (7.8%) had an asthma diagnosis. These cases were then matched, using propensity score matching, to a cohort of non-asthmatic children. These groups (7201 with asthma vs 7201 without) were then compared. The cumulative incidence of pneumonia was 4.5% among children without asthma versus 8.5% in those with asthma. The risk of pneumonia in the 30-day postoperative period was almost double in the asthmatic vs non asthmatic group. This study has some limitations, as retrospective details such as severity of asthma, treatment regimens, recent exacerbations and intraoperative management are not known. Similarly details of pneumonia diagnosis and severity are unknown.
Take home message
Bronchial asthma almost doubled the risk of postoperative pneumonia in children. These findings suggest that targeted perioperative interventions in these patients may be beneficial. Further prospective studies are necessary to identify the mechanism of increased susceptibility to postoperative pneumonia and to the role of perioperative pneumonia prevention strategies targeting children with an asthma diagnosis.
Reviewed by Kate O’Hare