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Aspiration pneumonia after antireflux surgery among neurologically impaired children with GERD.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
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2020 (English)In: Journal of Pediatric Surgery, ISSN 0022-3468, E-ISSN 1531-5037, article id S0022-3468(19)30934-0Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND AND OBJECTIVE: Aspiration pneumonia is a common and serious complication to gastroesophageal reflux disease (GERD) among neurologically impaired children. Medication of GERD does not effectively prevent aspiration pneumonia, and whether antireflux surgery with fundoplication is better in this respect is uncertain. The objective was to determine whether fundoplication prevents aspiration pneumonia among children with neurological impairment and GERD.

METHODS: This was a population-based cohort study from Denmark, Finland, Norway and Sweden, consisting of neurologically impaired children with GERD who underwent fundoplication. The risk of aspiration pneumonia before fundoplication (preoperative person-time) was compared with the risk after surgery (postoperative person-time). Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs). Except for confounding adjusted for by means of the "crossover like" design, the HRs were adjusted for age, sex, year of entry and respiratory diseases.

RESULTS: Among 578 patients (median age 3.5 years), the preoperative person-time was 956 years and the postoperative person-time was 3324 years. Fundoplication was associated with 56% decreased overall HR of aspiration pneumonia (HR 0.44, 95% CI 0.27-0.72), and the HRs decreased over time after surgery. The risk of other types of pneumonia than aspiration pneumonia was not clearly decreased after fundoplication (HR 0.79, 95% CI 0.59-1.08). The 30-day mortality rate was 0.7% and the complication rate was 3.6%.

CONCLUSIONS: Antireflux surgery decreases, but does not eliminate, the risk of aspiration pneumonia among neurologically impaired children with GERD. Fundoplication may be a treatment option when aspiration pneumonia is a recurrent problem in these children.

TYPE OF STUDY: Cohort study.

LEVEL OF EVIDENCE: Prognosis study-level I.

Place, publisher, year, edition, pages
2020. article id S0022-3468(19)30934-0
Keywords [en]
Fundoplication, GERD, GORD, Pediatric
Identifiers
URN: urn:nbn:se:uu:diva-404517DOI: 10.1016/j.jpedsurg.2019.12.024PubMedID: 32037217OAI: oai:DiVA.org:uu-404517DiVA, id: diva2:1395064
Available from: 2020-02-20 Created: 2020-02-20 Last updated: 2020-02-20

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