Asthma and Its Impact on Pediatric Patients Undergoing Surgical Management of Tibial Shaft Fractures

Abstract

IntroductionTibial shaft fractures are a common presenting injury among the pediatric population. Asthma is also a common diagnosis that is frequently encountered in this population and has a significant impact on healthcare utilization, quality of life, and mortality. Given the high prevalence of these conditions and risks of peri-anesthetic respiratory complications, the purpose of this study was to evaluate an association between asthma and the incidence of 30-day postoperative complications following the surgical management of tibial shaft fractures in the pediatric population. MethodsThe National Surgical Quality Improvement Program-Pediatric database was used to identify pediatric patients who underwent surgical treatment for tibial shaft fractures from 2013-2019. Patients were categorized into two groups: patients with a history of asthma and patients without a history of asthma. Differences in patient demographics, comorbidities, and postoperative complications were assessed using bivariate and multivariate analyses. ResultsOf the 2,649 patients who underwent surgical treatment for tibial shaft fractures, 115 (4.3%) had asthma. Compared to those without asthma, patients with a history of asthma were more likely to have other medical comorbidities. After controlling for the differences in baseline characteristics between the two groups, patients with asthma had an increased risk of prolonged hospital stay (OR 5.78; 95% CI 1.67 to 20.00; p=0.006). ConclusionPediatric patients being surgically treated for tibial shaft fractures with asthma had an increased risk of prolonged hospital stay. It is important that proper preoperative workup, perioperative care, and understanding of the implications of asthma on postoperative recovery are appreciated to reduce prolonged hospitalization lengths and minimize hospital costs associated with tibial shaft fracture surgery.

Racial Inequity in Pediatric Anesthesia

“…Using the National Surgical Quality Improvement Program Pediatric Participant Use Data File (NSQIP-P PUF), Krishna et al found that the risk of developing postoperative pneumonia within 30 days of inpatient pediatric surgery was almost double in children with asthma compared to those without [ 30 ]. Likewise, Tveit et al showed that children with asthma had nearly 6 times the risk of prolonged hospital stay following surgical management of tibial shaft fractures [ 31 ].…”