title: Reflux related hospital admissions after fundoplication in children with neurological impairment: retrospective cohort study.
abstract: OBJECTIVE
  To examine the impact of fundoplication on reflux related hospital admissions for children with neurological impairment.
  
  
  METHODS
  Retrospective, observational cohort study. Setting 42 children's hospitals in the United States.
  
  
  METHODS
  3721 children with neurological impairment born between 2000 and 2005 who had at least one hospital admission at a study hospital before their fundoplication.
  
  
  METHODS
  Fundoplication.
  
  
  METHODS
  Incident rate ratio for reflux related hospital admissions, defined as the post-fundoplication admission rate divided by the pre-fundoplication admission rate.
  
  
  RESULTS
  Of the 955 285 children born during the study period, 144,749 (15%) had neurological impairment. Of these, 27,720 (19%) were diagnosed as having gastro-oesophageal reflux disease, of whom 6716 (24%) had a fundoplication. Of these, 3721 (55%) had at least one previous hospital admission and were included in the study cohort. After fundoplication, hospital admissions decreased for any reflux related cause (incident rate ratio 0.69, 95% confidence interval 0.67 to 0.72; P<0.01), aspiration pneumonia (0.71, 0.62 to 0.81; P<0.01), gastro-oesophageal reflux disease (0.60, 0.57 to 0.63; P<0.01), and mechanical ventilation (0.40, 0.37 to 0.43; P<0.01), after adjustment for other patient and hospital related factors that may influence reflux related hospital admissions. Hospital admissions increased for asthma (incident rate ratio 1.52, 1.38 to 1.67; P<0.01) and remained constant for pneumonia (1.07, 0.98 to 1.17; P=0.16). Conclusions Children with neurological impairment who have fundoplication had reduced short term reflux related hospital admissions for aspiration pneumonia, gastro-oesophageal reflux disease, and mechanical ventilation. However, admissions for pneumonia remained constant and those for asthma increased after fundoplication. Comparative effectiveness data for other treatments (such as gastrojejunal feeding tubes) are unknown.
authors.affiliation: Division of Inpatient Medicine, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, USA. raj.srivastava@hsc.utah.edu
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Earl C
authors.initials: EC
authors.lastname: Downey
authors.forename: Molly
authors.initials: M
authors.lastname: O'Gorman
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
mesh_terms: D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D018662:Fundoplication / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009422:Nervous System Diseases / Q000150:complications*; D012189:Retrospective Studies; D055502:Secondary Prevention