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Factors associated with mortality after Nissen fundoplication in children
Joanne Baerg1, Donna Thorpe1, Alessandra Gasior2
1Department of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, California, United States.
Insights
Nissen fundoplication in children is associated with mortality, particularly in those with surgical complications, neurological impairment, or before 18 months of age. Female gender also emerged as a significant risk factor for mortality post-procedure.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Nissen fundoplication is a common surgical procedure for gastroesophageal reflux disease in children.
- Understanding factors associated with mortality is crucial for improving patient outcomes and surgical decision-making.
Purpose of the Study:
- To identify patient and surgical factors linked to mortality following Nissen fundoplication in pediatric patients.
- To analyze predictors of death in children undergoing this procedure.
Main Methods:
- Retrospective review of 412 children under 18 who underwent Nissen fundoplication between 1994 and 2010.
- Comparison of survivors and nonsurvivors using t-tests and chi-square tests.
- Logistic regression analysis to determine independent predictors of mortality.
Main Results:
- A total of 63 deaths (15.3%) occurred among the 412 included children.
- Significant univariate factors for mortality included surgical complications, female gender, neurological impairment, and fundoplication before 18 months.
- Independent predictors of mortality were surgical complications (OR 3.30), neurological impairment (OR 2.58), fundoplication before 18 months (OR 2.46), and female gender (OR 2.25).
Conclusions:
- Surgical complications, neurological impairment, undergoing fundoplication before 18 months, and female gender are independently associated with mortality after Nissen fundoplication in children.
- The median time to death for nonsurvivors was 6 months post-procedure.
Purpose:
The purpose of this article was to identify factors associated with mortality after Nissen fundoplication in children.
Methods:
After Institutional Review Board approval, children younger than 18 years, from two children's hospitals, with Nissen fundoplication performed between January 1994 and December 2010, were retrospectively reviewed. Inclusion required complete data and follow-up to October 2011. Survivors and nonsurvivors were compared, using t-tests for continuous and chi-square tests for categorical variables, to identify factors associated with mortality. Patient factors present before the first fundoplication were analyzed. Surgical factors were surgical complications, gastrostomy placement, operative technique, and redos. Logistic regression evaluated for independence of variables.
Results:
A total of 823 children were identified, 412 were included and 63 died (15.3%). The median follow-up time for the cohort was 3.7 years (mean, 4.5 ± 3.2 years). For nonsurvivors, the median time to death after fundoplication was 6.0 months (mean, 13.2 ± 8.0 months). Significant factors after univariate analysis were surgical complications (p = 0.001), female gender (p = 0.001), neurological impairment (p = 0.010), and fundoplication performed before the age of 18 months (p = 0.035). Independent predictors were surgical complications, odds ratio (OR), 3.30 (95% confidence interval [CI], 1.31-8.29), neurological impairment, OR, 2.58 (95% CI, 1.38-4.83), fundoplication before the age of 18 months, OR, 2.46 (95% CI, 1.23-4.94), and female gender, OR, 2.25 (95% CI, 1.26-4.00).
Conclusion:
After Nissen fundoplication in children, surgical complications, neurological impairment, fundoplication performed before the age of 18 months, and female gender are associated with mortality. The median time to death for nonsurvivors was 6 months.
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