Predictors of multiple readmissions or death in the first year after Nissen fundoplication in children

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Outcomes Research

Background:

• Nissen fundoplication (NF) is a common surgical procedure for pediatric gastro-esophageal reflux disease (GERD).
• Children undergoing NF often have complex co-morbidities, leading to variable reported outcomes.
• Predicting readmission and mortality after NF is crucial for patient management.

Purpose of the Study:

• To identify factors predicting multiple readmissions within the first year post-NF.
• To identify factors predicting mortality within the first year post-NF.
• To improve counseling for patients and caregivers regarding expectations after NF.

Main Methods:

• Retrospective chart review of 187 children undergoing NF between 2004 and 2015.
• Data collected included underlying medical conditions, age, weight, malnutrition, pre-operative hospital stay, and surgical type.
• Comparison of patients with multiple readmissions versus those with none/one, and deceased patients versus survivors.

Main Results:

• Risk factors for multiple readmissions included cardiac disease, esophageal atresia (EA), and esophageal stricture.
• Risk factors for death included younger age, need for a gastrostomy tube (GT), and prolonged pre-operative hospital admission.
• Statistical significance (p-values) was established for all identified risk factors.

Conclusions:

• Several factors significantly predict readmission and mortality in the first year after pediatric Nissen fundoplication.
• These findings aid in better patient and caregiver counseling regarding post-surgical expectations.
• Further research may refine risk stratification for pediatric NF.