title: Population-based comparison of open vs laparoscopic esophagogastric fundoplication in children: application of the Agency for Healthcare Research and Quality pediatric quality indicators.
abstract: OBJECTIVE
  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 χ(2) 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.
  
  
  CONCLUSIONS
  Laparoscopic fundoplication for gastroesophageal reflux in children can be performed safely compared with the open approach with equivalent or improved rates of PDIs.
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rhee
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Arnold
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
authors.forename: Jose H
authors.initials: JH
authors.lastname: Salazar-Osuna
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Chrouser
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Colombani
authors.affiliation: Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA. Electronic address: fa@jhmi.edu.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
mesh_terms: D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D018662:Fundoplication / Q000191:economics / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000191:economics / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000191:economics / Q000379:methods / Q000592:standards*; D007813:Laparotomy / Q000191:economics / Q000379:methods / Q000592:standards*; D008297:Male; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States; D016270:United States Agency for Healthcare Research and Quality