Aspiration pneumonia after antireflux surgery among neurologically impaired children with GERD

John Maret-Ouda, Giola Santoni, Miia Artama, Eivind Ness-Jensen, Jan F Svensson, My von Euler-Chelpin, Jesper Lagergren

Research output: Contribution to journalArticleScientificpeer-review


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.

Original languageEnglish
Pages (from-to)2408-2412
Number of pages5
JournalJournal of Pediatric Surgery
Issue number11
Publication statusPublished - Nov 2020
Externally publishedYes
Publication typeA1 Journal article-refereed


  • Child
  • Child, Preschool
  • Cohort Studies
  • Denmark
  • Finland
  • Fundoplication/adverse effects
  • Gastroesophageal Reflux/surgery
  • Humans
  • Norway
  • Pneumonia, Aspiration/complications
  • Sweden


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