A prospective analysis of factors influencing outcome after fundoplication.
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)
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001835:Body Weight; D001925:Brain Damage, Chronic / Q000601:surgery; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D003907:Dexamethasone / Q000627:therapeutic use; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000150:complications; D011014:Pneumonia / Q000209:etiology; D011300:Preoperative Care; D011446:Prospective Studies; D012008:Recurrence; D012121:Respiration, Artificial; D012709:Serum Albumin / Q000032:analysis; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D012709:Serum Albumin; D003907:Dexamethasone