Laparoscopic pyloromyotomy decreases postoperative length of stay in children with hypertrophic pyloric stenosis.
OBJECTIVE
To determine the impact of laparoscopic versus open pyloromyotomy on postoperative length of stay (LOS).


METHODS
The 2013 National Surgical Quality Improvement Project Pediatric database was queried for all cases of pyloromyotomy performed on children <1year old with congenital hypertrophic pyloric stenosis. Demographics, clinical, and perioperative characteristics for patients with and without a prolonged postoperative LOS, defined as >1day, were compared. Logistic regression modeling was performed to identify factors associated with a prolonged postoperative LOS.


RESULTS
Out of 1143 pyloromyotomy patients, 674 (59%) underwent a laparoscopic procedure. Patients undergoing open pyloromyotomy had a longer operative time (median 28 vs. 25min, p<0.001) but shorter duration of general anesthesia (median 72 vs. 78min, p<0.001). Patients undergoing open pyloromyotomy more frequently had a prolonged postoperative LOS (32% vs. 26%, p=0.019). Factors independently associated with postoperative LOS >1day included open pyloromyotomy (odds ratio, 95% confidence interval, p-value) (1.38, 1.03-1.84, p=0.030), cardiac comorbidity (3.64, 1.45-9.14, p=0.006), pulmonary comorbidity (3.47, 1.15-10.46, p=0.027), lower weight (1.005 per 100g decrease, 1.002-1.007, p<0.001), longer preoperative LOS (1.35 per additional day, 1.13-1.62, p=0.001), longer operative time (1.11 per additional 5min, 1.05-1.17, p<0.001), higher preoperative blood urea nitrogen (1.04 per additional mg/dl, 1.01-1.07, p=0.012), and higher serum sodium (1.08 per additional mg/dl, 1.03-1.14, p=0.004).


CONCLUSIONS
Compared to laparoscopic pyloromyotomy, open pyloromyotomy is independently associated with a higher likelihood of a prolonged postoperative LOS.
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Justin B
JB
Mahida
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Lindsey
L
Asti
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Katherine J
KJ
Deans
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Peter C
PC
Minneci
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH. Electronic address: Jonathan.Groner@nationwidechildrens.org.
Jonathan I
JI
Groner
D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D046248:Pyloric Stenosis, Hypertrophic / Q000151:congenital / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*
ACS NSQIP pediatric; Laparoscopic procedure; Pediatrics; Postoperative length of stay; Pyloromyotomy