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A prospective analysis of factors influencing outcome after fundoplication
1Division of Pediatric Surgery, St Louis University School of Medicine, MO, USA.
Insights
Poor nutritional status and dexamethasone use in brain-damaged children undergoing fundoplication are linked to increased complications and recurrence. Addressing these factors may improve surgical outcomes for pediatric GERD patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Fundoplication is common in brain-damaged children with GERD.
- Recent data suggest poor outcomes in this population.
- Factors influencing fundoplication success require further examination.
Purpose of the Study:
- To identify preoperative factors associated with complications and recurrence after Nissen fundoplication in brain-damaged pediatric patients.
- To evaluate the impact of nutritional status and medication use on surgical outcomes.
Main Methods:
- Prospective analysis of 56 brain-damaged children (6 months-12 years) undergoing Nissen fundoplication.
- Preoperative nutritional assessment (ideal body weight, albumin, Nutrition Risk Index [NRI]).
- Documentation of dexamethasone use for bronchopulmonary dysplasia.
Main Results:
- 54% of patients experienced major complications.
- Low albumin (< 3.5 g/dL) and low NRI (< 90) significantly correlated with prolonged hospitalization, ICU stay, and ventilator time.
- Recurrence (21%) was linked to dexamethasone use, particularly when combined with nutritional deficits (low albumin or NRI).
Conclusions:
- Preoperative nutritional deficiencies and dexamethasone use are significant risk factors for fundoplication complications and recurrence in brain-damaged children.
- Optimizing nutritional status and reconsidering dexamethasone use may improve outcomes.
- Further research is warranted to refine surgical strategies for this vulnerable pediatric population.
Abstract:
Fundoplication remains a common operation in the brain-damaged pediatric patient, but recent reports suggest a poor outcome in these patients. The factors that might be associated with complications or recurrence after fundoplication have not been extensively examined. Fifty-six brain-damaged children, aged 6 months to 12 years, with documented gastroesophageal (GE) reflux underwent preoperative nutritional evaluations (percentage of ideal weight, albumin, nutrition risk index [NRI]) and documentation of medications (dexamethasone for bronchopulmonary dysplasia) before standard Nissen fundoplication. Hospital stay, intensive care unit (ICU) stay, and time on ventilator, as well as major postoperative complications (wound infection/dehiscence, pneumonia) were prospectively analyzed. Survival and recurrence rates 1 to 3 years postoperatively were also assessed. Eighty-two percent of patients were < 90% ideal weight, and 50% had NRI < 90 (normal = 100) and 29% had albumin < 3.5 g/dL. Albumin < 3.5 was significantly (P < .01) associated with prolonged hospitalization (26.8 + 2.2 versus 15.1 + 1.1 days) and ICU stay (13.8 + 1.0 versus 4.4 + .5 days) and time on ventilator (8.0 + 1.0 versus 1.8 + .4 days). NRI < 90 showed similar significant differences (P < .01). Ideal body weight < 90% was not significant. Major complications developed in 54% of patients; only two or more preoperative nutritional deficiencies, or a nutritional deficiency plus dexamethasone were significantly associated (P < .01). Recurrence occurred in 21% of patients and was significantly correlated with preoperative dexamethasone alone (P < .01), and especially when dexamethasone plus a nutritional deficit were present (low albumin, P < .001; low NRI, P < .005).(ABSTRACT TRUNCATED AT 250 WORDS)