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Outcomes of laparoscopic versus open fundoplication in children's hospitals: 2005-2008
David Fox1, Elaine Morrato, Elizabeth J Campagna
1The Children's Hospital, 13123 East 16th Ave, Aurora, CO 80045, USA. fox.david@tchden.org
Insights
Laparoscopic fundoplication in children offers better outcomes, including fewer infections and complications, compared to open surgery. This minimally invasive approach is increasingly common and cost-effective for pediatric antireflux procedures.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Fundoplication is a frequent surgical procedure for children.
- Limited comparative data exist for laparoscopic versus open approaches.
Purpose of the Study:
- Compare infection rates, complication rates, length of stay, and costs between laparoscopic and open fundoplication in pediatric patients.
- Analyze trends in the utilization of laparoscopic fundoplication.
Main Methods:
- Retrospective analysis of the Pediatric Health Information System database (2005-2008).
- Inclusion of children (<19 years) undergoing fundoplication.
- Multivariate regression with hospital-level random effects to assess outcomes.
Main Results:
- Laparoscopic fundoplication was performed in 56% of 7083 cases.
- Shorter median length of stay (4 vs. 10 days) and lower median cost ($13,003 vs. $22,487) for laparoscopic approach.
- Reduced adjusted odds of infection (24%) and surgical complications (51%) with laparoscopic fundoplication.
- Increased laparoscopic fundoplication rate from 51% to 63% (2005-2008) without increasing overall procedure rates.
Conclusions:
- Laparoscopic fundoplication demonstrates superior outcomes in pediatric patients compared to open surgery.
- The laparoscopic approach is now the predominant method for antireflux surgery in children over one year old.
- Findings impact clinical practice and surgical training for pediatric fundoplication.
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.
