title: Antireflux procedures for gastroesophageal reflux disease in children: influence of patient age on surgical management.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) is a common diagnosis in infants and children, but no objective criteria exist to guide the diagnosis and treatment of this disease in this population. The extent to which age influences decisions about surgical treatment in childhood GERD is unknown.
  
  
  OBJECTIVE
  To identify factors associated with progression to antireflux procedures (ARPs) in children hospitalized with GERD.
  
  
  METHODS
  Retrospective cohort study using inpatient data from 41 US children's hospitals in the Pediatric Health Information System database. We included patients younger than 18 years discharged from January 1, 2002, through December 31, 2010, with primary diagnostic codes for GERD (n = 141 190). We evaluated demographics, comorbidities, and diagnostic procedures descriptively and with a multivariate Cox proportional hazards regression model.
  
  
  METHODS
  Patient age.
  
  
  METHODS
  Proportional hazard of progression to ARP during admission.
  
  
  RESULTS
  Of the 141,190 patients meeting study criteria, 11,621 (8.2%) underwent ARPs during the study period. More than half of patients undergoing ARPs (52.7%) were 6 months or younger. Although most patients in the ARP group had preoperative upper gastrointestinal tract fluoroscopy (65.0%), these patients did not undergo a uniform workup. The hazard of progression to an ARP was significantly decreased in children aged 7 months to 4 years (hazard ratio, 0.63 [P < .001]) and 5 to 17 years (0.43 [P < .001]) relative to children younger than 2 months. Hazard ratios were independently increased for comorbid diagnoses of failure to thrive, neurodevelopmental delay, cardiopulmonary anomalies, cerebral palsy, and aspiration pneumonia and among patients with tracheoesophageal fistula and diaphragmatic hernia. Each additional GERD-related hospitalization was associated with a 10% increased risk of an ARP. CONCLUSIONS AND REVELANCE: Antireflux procedures are most commonly performed in children during a period of life when regurgitation is normal and physiologic and objective measures of GERD are difficult to interpret. To identify meaningful outcomes after ARP, indications must be clear and standardized. We must clarify the appropriate workup for infants and young children with GERD and better define "failure of medical management" in this population.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington2Department of Surgery, University of Washington School of Medicine, Seattle.
authors.forename: Jarod
authors.initials: J
authors.lastname: McAteer
authors.affiliation: Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Cindy
authors.initials: C
authors.lastname: Larison
authors.affiliation: Department of Surgery, Louisiana State University, New Orleans.
authors.forename: Cabrini
authors.initials: C
authors.lastname: LaRiviere
authors.affiliation: Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Garrison
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington2Department of Surgery, University of Washington School of Medicine, Seattle.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies