Effectiveness of fundoplication at the time of gastrostomy in infants with neurological impairment.
OBJECTIVE
Gastrostomy tube (GT) placement is the most common gastrointestinal operation performed on neonates. Concomitant fundoplication is used variably to prevent complications of gastroesophageal reflux, but its effectiveness is unproven.


OBJECTIVE
To compare the effect of fundoplication at the time of GT placement vs GT placement alone on subsequent reflux-related hospitalizations in infants with neurological impairment.


METHODS
Retrospective, observational cohort study, defined by birth between January 1, 2005, and December 31, 2010, at 42 children's hospitals in the United States, with a 1-year follow-up period among 4163 infants with neurological impairment who underwent GT placement with or without fundoplication during their neonatal intensive care unit stay.


METHODS
Fundoplication and GT placement vs. GT placement alone.


METHODS
One-year postprocedural reflux-related hospitalization rates, defined as hospitalization for asthma, mechanical ventilation, gastroesophageal reflux disease, and aspiration or other types of pneumonia. Propensity to undergo concomitant fundoplication was modeled using demographics, prior procedures (tracheostomy and mechanical ventilation), and prior diagnoses (eg, pneumonia, gastroesophageal reflux disease, and other comorbidities).


RESULTS
Overall, 4163 of 42,796 infants (9.7%) with neurological impairment admitted to the neonatal intensive care unit underwent GT placement alone or with fundoplication. Infants who concomitantly underwent fundoplication had more reflux-related hospitalizations during the first year than those who underwent GT placement alone (mean, 1.02; 95% CI, 0.93-1.10 vs mean, 0.92; 95% CI, 0.91-1.00). Of 1404 infants who underwent fundoplication, 1027 (73.1%) were matched based on propensity scores. The mean difference of the matched cohort for any reflux-related hospitalizations was -0.05 (95% CI, -0.20 to 0.15) per year.


CONCLUSIONS
Infants with neurological impairment who underwent fundoplication at the time of GT placement did not have a reduced rate of reflux-related hospitalizations during the first year compared with those who underwent GT placement alone, despite propensity score matching. This may be due to a lack of effectiveness of fundoplication in preventing these complications or due to differences in the patient groups that were inadequately accounted for in the matching.
Department of Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City.
Douglas C
DC
Barnhart
Matthew
M
Hall
Sanjay
S
Mahant
Adam B
AB
Goldin
Jay G
JG
Berry
Roger G
RG
Faix
J Michael
JM
Dean
Rajendu
R
Srivastava
D001927:Brain Diseases / Q000150:complications; D057186:Comparative Effectiveness Research; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D057216:Propensity Score; D012189:Retrospective Studies