Population-level surgical outcomes for infantile hypertrophic pyloric stenosis

• Published in: Journal of pediatric surgery 2018-03, Vol.53 (3), p.540-544
• Main Authors: Lansdale, Nick, Al-Khafaji, Nadeem, Green, Patrick, Kenny, Simon E
• Format: Article
• Language: English
• Subjects: Hospital episode statistics; Infant; Outcomes; Pediatrics; Pyloric stenosis; Pyloromyotomy; Surgery; Volume-outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2017.05.018

Abstract Objectives Determine national outcomes for pyloromyotomy; how these are affected by: (i) surgical approach (open/laparoscopic), or (ii) centre type/volume and establish potential benchmarks of quality. Methods Hospital Episode Statistics data were analysed for admissions 2002–2011. Data presented as median (IQR). Results 9686 infants underwent pyloromyotomy (83% male). Surgery was performed in 22 specialist (SpCen) and 39 nonspecialist centres (NonSpCen). The proportion treated in SpCen increased linearly by 0.4%/year (r = 0.76, p = 0.01). Annual case volume in SpCen vs. NonSpCen was 40 (24–53) vs. 1 (0–3). Time to surgery was shorter in SpCen (1 day [1, 2] vs. 2 [1–3]), but total stay equal (4 days [3–6]). 137 (1.4%) had complications requiring reoperation (wound problem 0.6%; repeat pyloromyotomy 0.5% and perforation, bleeding or obstruction 0.2%): pooled rates were similar between SpCen and NonSpCen (1.4% vs. 1.6%, p = 0.52). Three NonSpCen had > 5% reoperations (within 99.8% C.I. as small denominators). There was no relationship between reoperation and centre volume. Laparoscopic pyloromyotomy had increased risk of repeat pyloromyotomy (OR 2.28 [1.14–4.57], p = 0.029). Conclusions Pyloric stenosis surgery shifted from centres local to patients, but outcomes were unaffected by centre type/volume. Modest reported benefits of laparoscopy appear offset by increased reoperations. Quality benchmarks could be set for reoperation < 4%. Type of study Treatment Study. Level of evidence Level III.