TY - JOUR
T1 - Population-based comparison of open vs laparoscopic esophagogastric fundoplication in children
T2 - Application of the Agency for Healthcare Research and Quality pediatric quality indicators
AU - Rhee, Daniel
AU - Zhang, Yiyi
AU - Chang, David C.
AU - Arnold, Meghan A.
AU - Salazar-Osuna, Jose H.
AU - Chrouser, Kristin
AU - Colombani, Paul M.
AU - Abdullah, Fizan
PY - 2011/4
Y1 - 2011/4
N2 - Background/Purpose: Increasing national focus on patient safety has promoted development of the pediatric quality indicators (PDIs), which screen for preventable events during provision of health care for children. Our objective is to apply these safety metrics to compare 2 surgical procedures in children, specifically laparoscopic and open esophagogastric fundoplication for gastroesophageal reflux. Methods: A retrospective analysis using 20 years of data from national representative state inpatient databases through the Healthcare Cost and Utilization Project was conducted. Patients younger than 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for open or laparoscopic esophagogastric fundoplication were included. Pediatric quality indicators were linked to each patient's profile. Demographics, comorbidities, outcomes, and 8 selected PDIs between open and laparoscopic fundoplications were compared using Pearson χ2 tests and t tests. Results: Of 33,533 patients identified, 28,141 underwent open and 5392 underwent laparoscopic fundoplication. Comorbidities occurred more frequently in open surgery. In-hospital mortality, length of stay, and hospital charges were less in laparoscopic surgery. Of the 8 PDIs evaluated, decubitus ulcer (P = .04) and postoperative sepsis (P = .003) had decreased rates with laparoscopic surgery compared with open. Conclusion: Laparoscopic fundoplication for gastroesophageal reflux in children can be performed safely compared with the open approach with equivalent or improved rates of PDIs.
AB - Background/Purpose: Increasing national focus on patient safety has promoted development of the pediatric quality indicators (PDIs), which screen for preventable events during provision of health care for children. Our objective is to apply these safety metrics to compare 2 surgical procedures in children, specifically laparoscopic and open esophagogastric fundoplication for gastroesophageal reflux. Methods: A retrospective analysis using 20 years of data from national representative state inpatient databases through the Healthcare Cost and Utilization Project was conducted. Patients younger than 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for open or laparoscopic esophagogastric fundoplication were included. Pediatric quality indicators were linked to each patient's profile. Demographics, comorbidities, outcomes, and 8 selected PDIs between open and laparoscopic fundoplications were compared using Pearson χ2 tests and t tests. Results: Of 33,533 patients identified, 28,141 underwent open and 5392 underwent laparoscopic fundoplication. Comorbidities occurred more frequently in open surgery. In-hospital mortality, length of stay, and hospital charges were less in laparoscopic surgery. Of the 8 PDIs evaluated, decubitus ulcer (P = .04) and postoperative sepsis (P = .003) had decreased rates with laparoscopic surgery compared with open. Conclusion: Laparoscopic fundoplication for gastroesophageal reflux in children can be performed safely compared with the open approach with equivalent or improved rates of PDIs.
KW - Fundoplication
KW - Gastroesophageal reflux disease
KW - Outcomes
KW - Pediatric
KW - Quality
KW - Safety
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U2 - 10.1016/j.jpedsurg.2010.09.012
DO - 10.1016/j.jpedsurg.2010.09.012
M3 - Article
C2 - 21496532
AN - SCOPUS:79954562274
SN - 0022-3468
VL - 46
SP - 648
EP - 654
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 4
ER -