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Hypertrophic pyloric stenosis in the Maritimes: examining the waves of change over time
Alexander C Ednie1, Ofer Amram1, Jenna Colleen Creaser1
1From the Department of General Surgery, Dalhousie University, Halifax, NS (Ednie); the Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC (Amram); the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Amram); the University of British Columbia, Vancouver, BC (Creaser); the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman); the Department of Pediatric Surgery, Centre Hospitalier Universitaire de Queébec, Québec, Que. (Leclerc); the Departments of Surgery and Community Health and Epidemiology, Dalhousie University, Halifax, NS (Yanchar); and the Department of Pediatric General Surgery, IWK Health Centre, Halifax, NS (Yanchar).
Insights
Treating infants with hypertrophic pyloric stenosis (HPS) at pediatric centers improves outcomes and reduces complications. Centralized care minimizes travel burdens for families seeking surgical treatment for HPS.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Healthcare Access
Background:
- Referral and management patterns for pediatric surgical conditions like hypertrophic pyloric stenosis (HPS) are evolving.
- Families face significant travel burdens for specialized pediatric surgical care.
- Understanding referral patterns is crucial for optimizing HPS treatment access.
Purpose of the Study:
- To assess HPS referral patterns in Canada's Maritime provinces over a decade.
- To quantify the travel burden on families seeking HPS surgical care.
- To evaluate the impact of treatment location on outcomes and length of stay.
Main Methods:
- Retrospective chart review of 751 HPS cases in the Maritimes (2001-2010).
- Analysis of length of hospital stay (LOS) and complication rates based on treatment center (pediatric vs. peripheral).
- Utilized patient postal codes to calculate travel distances for management.
Main Results:
- Referrals to pediatric centers increased from 49% to 71% during the study period.
- Peripheral centers had 2.5-fold higher postoperative complication rates.
- Infants treated at pediatric centers were 78% less likely to have LOS >3 days; laparoscopic pyloromyotomy, exclusive to pediatric centers, correlated with shorter LOS.
Conclusions:
- Treatment of HPS in pediatric centers is associated with better outcomes, reduced LOS, and fewer complications.
- Centralized pediatric surgical resources are vital for optimizing care for infants with HPS.
- Consideration of travel burden and specialized care access is essential for healthcare planning.
Background:
Changing patterns of referral and management of pediatric surgical conditions, including hypertrophic pyloric stenosis (HPS), have recently been described and often relate to comfort with early nonoperative management, anesthesia and corrective surgery. Travelling distance required for treatment at pediatric centres can also be burdensome for families. We assessed referral patterns for HPS in the maritime provinces of Canada over 10 years to quantify the burden on families travelling for surgical care.
Methods:
We reviewed the charts of all patients with HPS in the Maritimes. Length of hospital stay (LOS) and complication rates were analyzed in regards to resuscitation and management at a pediatric centre and/or peripheral centres. We used postal codes for each patient to track distance travelled for management.
Results:
We assessed 751 cases of HPS. During the study period (Jan. 1, 2001-Dec. 31, 2010), referral to pediatric centres increased from 49% to 71%. Postoperative complications were 2.5-fold higher in peripheral centres. Infants referred to pediatric centres were 78% less likely to have an LOS longer than 3 days. Laparoscopic pyloromyotomy, which was performed only in pediatric centres, was associated with a shorter postoperative LOS.
Conclusion:
Our study supports the current literature demonstrating improved outcomes, shorter overall LOS and decreased risk of complications when infants with HPS are treated in pediatric centres. This should be considered when planning access to pediatric surgical resources.
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