Hypertrophic pyloric stenosis in the Maritimes: examining the waves of change over time.
BACKGROUND
Changing patterns of referral and management of pediatric surgical conditions, including hypertrophic pyloric stenosis (HPS), have recently been described and often relate to comfort with early nonoperative management, anesthesia and corrective surgery. Travelling distance required for treatment at pediatric centres can also be burdensome for families. We assessed referral patterns for HPS in the maritime provinces of Canada over 10 years to quantify the burden on families travelling for surgical care.


METHODS
We reviewed the charts of all patients with HPS in the Maritimes. Length of hospital stay (LOS) and complication rates were analyzed in regards to resuscitation and management at a pediatric centre and/or peripheral centres. We used postal codes for each patient to track distance travelled for management.


RESULTS
We assessed 751 cases of HPS. During the study period (Jan. 1, 2001-Dec. 31, 2010), referral to pediatric centres increased from 49% to 71%. Postoperative complications were 2.5-fold higher in peripheral centres. Infants referred to pediatric centres were 78% less likely to have an LOS longer than 3 days. Laparoscopic pyloromyotomy, which was performed only in pediatric centres, was associated with a shorter postoperative LOS.


CONCLUSIONS
Our study supports the current literature demonstrating improved outcomes, shorter overall LOS and decreased risk of complications when infants with HPS are treated in pediatric centres. This should be considered when planning access to pediatric surgical resources.
From the Department of General Surgery, Dalhousie University, Halifax, NS (Ednie); the Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC (Amram); the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Amram); the University of British Columbia, Vancouver, BC (Creaser); the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman); the Department of Pediatric Surgery, Centre Hospitalier Universitaire de Queébec, Québec, Que. (Leclerc); the Departments of Surgery and Community Health and Epidemiology, Dalhousie University, Halifax, NS (Yanchar); and the Department of Pediatric General Surgery, IWK Health Centre, Halifax, NS (Yanchar).
Alexander C
AC
Ednie
From the Department of General Surgery, Dalhousie University, Halifax, NS (Ednie); the Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC (Amram); the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Amram); the University of British Columbia, Vancouver, BC (Creaser); the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman); the Department of Pediatric Surgery, Centre Hospitalier Universitaire de Queébec, Québec, Que. (Leclerc); the Departments of Surgery and Community Health and Epidemiology, Dalhousie University, Halifax, NS (Yanchar); and the Department of Pediatric General Surgery, IWK Health Centre, Halifax, NS (Yanchar).
Ofer
O
Amram
From the Department of General Surgery, Dalhousie University, Halifax, NS (Ednie); the Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC (Amram); the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Amram); the University of British Columbia, Vancouver, BC (Creaser); the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman); the Department of Pediatric Surgery, Centre Hospitalier Universitaire de Queébec, Québec, Que. (Leclerc); the Departments of Surgery and Community Health and Epidemiology, Dalhousie University, Halifax, NS (Yanchar); and the Department of Pediatric General Surgery, IWK Health Centre, Halifax, NS (Yanchar).
Jenna Colleen
JC
Creaser
From the Department of General Surgery, Dalhousie University, Halifax, NS (Ednie); the Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC (Amram); the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Amram); the University of British Columbia, Vancouver, BC (Creaser); the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman); the Department of Pediatric Surgery, Centre Hospitalier Universitaire de Queébec, Québec, Que. (Leclerc); the Departments of Surgery and Community Health and Epidemiology, Dalhousie University, Halifax, NS (Yanchar); and the Department of Pediatric General Surgery, IWK Health Centre, Halifax, NS (Yanchar).
Nadine
N
Schuurman
From the Department of General Surgery, Dalhousie University, Halifax, NS (Ednie); the Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC (Amram); the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Amram); the University of British Columbia, Vancouver, BC (Creaser); the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman); the Department of Pediatric Surgery, Centre Hospitalier Universitaire de Queébec, Québec, Que. (Leclerc); the Departments of Surgery and Community Health and Epidemiology, Dalhousie University, Halifax, NS (Yanchar); and the Department of Pediatric General Surgery, IWK Health Centre, Halifax, NS (Yanchar).
Suzanne
S
Leclerc
From the Department of General Surgery, Dalhousie University, Halifax, NS (Ednie); the Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, BC (Amram); the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, BC (Amram); the University of British Columbia, Vancouver, BC (Creaser); the Department of Geography, Simon Fraser University, Vancouver, BC (Schuurman); the Department of Pediatric Surgery, Centre Hospitalier Universitaire de Queébec, Québec, Que. (Leclerc); the Departments of Surgery and Community Health and Epidemiology, Dalhousie University, Halifax, NS (Yanchar); and the Department of Pediatric General Surgery, IWK Health Centre, Halifax, NS (Yanchar).
Natalie
N
Yanchar
D017281:Cost of Illness; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009509:New Brunswick / Q000453:epidemiology; D009674:Nova Scotia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011325:Prince Edward Island / Q000453:epidemiology; D046248:Pyloric Stenosis, Hypertrophic / Q000453:epidemiology / Q000601:surgery*; D012017:Referral and Consultation / Q000706:statistics & numerical data*
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