title: Survival of children following Nissen fundoplication.
abstract: BACKGROUND
  Analyses of survival after fundoplication in childhood are often restricted to 30-day mortality, or to the neurologically impaired. The objective of this study was to report actuarial survival and variables associated with mortality for all children undergoing fundoplication.
  
  
  METHODS
  This was a prospective observational study of fundoplication surgery by one surgeon; the endpoint was survival. Using a Cox proportional hazards model, gastrostomy, neurological status, tracheostomy, congenital cardiac disease, syndromic status, presence of congenital anomaly, other chronic disease, weight z-score at time of surgery, need for revisional fundoplication, use of laparoscopic surgery, gastric drainage procedures, age and sex were assessed for their influence on survival.
  
  
  RESULTS
  Two-hundred and thirty children underwent 255 fundoplications at a median age of 3·6 years. Forty-six children (20·0 per cent) died during a median follow-up of 2·8 (range 0·5-11·2) years. Statistical modelling showed gastrostomy (relative risk of death 11·04, P < 0·001), cerebral palsy (relative risk 6·58, P = 0·021) and female sex (relative risk 2·12, P = 0·015) to be associated with reduced survival. Revisional fundoplication was associated with improved survival (relative risk of death 0·37, P = 0·037). Survivors had significantly higher weight z-scores (-1·4 versus - 2·9 for those who died; P = 0·001). The 5-year survival rate after fundoplication for children with cerebral palsy and gastrostomy was 59 per cent.
  
  
  CONCLUSIONS
  Survival of children following fundoplication is related principally to the presence of a gastrostomy and neurological status. Estimates of children's life expectancy should take account of the poorer survival of neurologically impaired children who undergo fundoplication, presumably due to the related co-morbidities that lead to a gastrostomy.
authors.affiliation: Department of Paediatric Surgery, The Royal Victoria Infirmary, University of Newcastle, Newcastle upon Tyne, UK.
authors.forename: R
authors.initials: R
authors.lastname: Wockenforth
authors.forename: C S
authors.initials: CS
authors.lastname: Gillespie
authors.forename: B
authors.initials: B
authors.lastname: Jaffray
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005183:Failure to Thrive / Q000401:mortality / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000401:mortality*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005774:Gastrostomy / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012086:Reoperation / Q000401:mortality; D012307:Risk Factors; D014839:Vomiting / Q000401:mortality / Q000601:surgery; D055815:Young Adult