Outcomes of laparoscopic versus open fundoplication in children's hospitals: 2005-2008 Articles uri icon

authors

  • Fox, D.
  • Morrato, E.
  • Campagna, E.J.
  • REES, DANIEL IRA
  • Dickinson, L.M.
  • Partrick, D.A.
  • Kempe, A.

publication date

  • January 2011

start page

  • 872

end page

  • 880

issue

  • 5

volume

  • 127

International Standard Serial Number (ISSN)

  • 0031-4005

Electronic International Standard Serial Number (EISSN)

  • 1098-4275

abstract

  • BACKGROUND: Fundoplication is a common pediatric surgery, but little data comparing the laparoscopic approach with the open approach have been published. OBJECTIVE: To compare infection rates, complication rates, length of stay, and cost for laparoscopic fundoplication versus open fundoplication among pediatric patients and to examine trends in utilization of laparoscopic fundoplication. METHODS: We used the Pediatric Health Information System database to conduct a retrospective study of children (aged <19 years) admitted for a fundoplication between 2005 and 2008. Descriptive characteristics for those undergoing a laparoscopic and open fundoplication were compared. Multivariate regression with random effects specified at the hospital level was used to model the association between laparoscopic fundoplication and the outcomes. RESULTS: Fifty-six percent of 7083 fundoplication admissions had laparoscopic fundoplication. Median length of stay was 4 days for laparoscopic and 10 days for open fundoplication. The median cost of laparoscopic fundoplication was $13 003 versus $22 487 for open fundoplication. Laparoscopic fundoplication was associated with a 24% and 51% reduction in the adjusted odds of infection and surgical complications, respectively. The proportion of fundoplications performed laparoscopically increased from 51% in 2005 to 63% in 2008 (P < .001), but there was no increase in the overall fundoplication rate. CONCLUSIONS: In a large study of children's hospitals, laparoscopic fundoplication was associated with improved outcomes compared with the open procedure, even after adjustment for patient severity. Laparoscopic fundoplication has become the most common form of antireflux surgery in children over 1 year of age, but this has not been associated with an increase in the overall utilization of the fundoplication procedure. These data have important implications for clinical practice and surgical training. Copyright © 2011 by the American Academy of Pediatrics.

keywords

  • fundoplication laparoscopic fundoplication neurologic impairment open fundoplication surgical outcomes adolescent article child controlled study data base female health care cost human infant intermethod comparison laparoscopic surgery length of stay major clinical study male newborn pediatric health information system postoperative complication postoperative infection preschool child priority journal retrospective study school child stomach fundoplication treatment outcome united states adolescent child child; preschool databases; factual female follow-up studies fundoplication health care surveys hospitals; pediatric humans laparoscopy laparotomy length of stay male multivariate analysis pain measurement postoperative complications regression analysis statistics; nonparametric surgical wound infection treatment outcome united states