Increased morbidity and mortality in cardiac patients undergoing fundoplication

Heather L. Short, Curtis Travers, Courtney McCracken, Mark L. Wulkan, Matthew S. Clifton, Mehul V. Raval*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Infants with congenital cardiac disease (CCD) often require gastrostomy tube placement (GT) and need antireflux procedures, such as fundoplications. Our purpose was to compare morbidity/mortality rates among infants with CCD undergoing GT, fundoplication, or both. Methods: Using the NSQIP-Pediatric, we identified 4070 patients <1-year-old who underwent GT and/or fundoplication from 2012 to 2014. 2346 infants (58%) had CCD categorized as minor, major or severe. Regression models were used to estimate the association of CCD with morbidity/mortality. Results: Among all patients undergoing fundoplication, there were increased odds of morbidity/mortality among CCD patients compared to non-CCD patients (OR 2.15; p < 0.001). Odds of complications decreased when procedures were performed laparoscopically or later in the first year of life. Using GT alone as a reference, fundoplication alone (OR 1.67; p < 0.001) and GT with fundoplication (OR 1.82; p < 0.001) had increased odds of morbidity/mortality among cardiac patients. Increased risk persisted after stratification by severity of CCD and after accounting for surgical approach. Conclusion: Fundoplication is associated with increased odds of morbidity/mortality in infants with CCD compared to GT alone. Risks are lower with laparoscopic approach and if surgery is delayed until later in the first year of life. Timing and surgical approach for patients with CCD requires further investigation.

Original languageEnglish (US)
Pages (from-to)559-567
Number of pages9
JournalPediatric Surgery International
Volume33
Issue number5
DOIs
StatePublished - May 1 2017

Keywords

  • Congenital cardiac disease
  • Fundoplication
  • GERD
  • Gastrostomy
  • NSQIP-P

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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