Neonatal outcomes following open versus minimally invasive surgery for duodenal atresia: A propensity score matched...

This study aims to evaluate outcomes for neonates undergoing open versus minimally invasive surgery (MIS) for duodenal atresia repair using a propensity score matched cohort from a national database.

Neonates undergoing duodenal atresia repair from 2016 to 2023 were identified using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Baseline characteristics of each group were matched using propensity scores. Outcomes were compared using an intention-to-treat analysis. Pearson's chi-square, Fisher's exact, and Mann-Whitney's U tests were used as appropriate. Annual operative trends were assessed using a Cochran-Armitage trend test.

A total of 1485 neonates were identified who underwent duodenal atresia repair. Pre-match, neonates who underwent open repair were smaller, more often premature, required more ventilator support, more frequently required emergent interventions, and had higher ASA class compared to MIS. There were 206 neonates included in each group after propensity score matching (PSM). These groups were similar in baseline characteristics. Post-match, MIS repair was associated with a longer median operative time (open 111 min, IQR 87-143 vs MIS 166 min, IQR 127-206, p < 0.001). There were no differences in composite morbidity (open 18.5% vs MIS 12.1%, p = 0.08), readmission (open 0.5% vs MIS 1.0%, p = 0.56), reinterventions (open 2.9% vs MIS 4.4%, p = 0.43), or postoperative admission lasting >30 days (open 40.3% vs MIS 32.0%, p = 0.08). MIS utilization increased significantly over the study period (p = 0.006).

In this matched cohort, MIS was associated with similar outcomes as the open approach, with the exception of longer operative times. MIS repair of duodenal atresia has steadily increased over the study period.

Retrospective comparative study.

Level III.