title: Increased morbidity and mortality in cardiac patients undergoing fundoplication.
abstract: BACKGROUND
  Infants with congenital cardiac disease (CCD) often require gastrostomy tube placement (GT) and need antireflux procedures, such as fundoplications. Our purpose was to compare morbidity/mortality rates among infants with CCD undergoing GT, fundoplication, or both.
  
  
  METHODS
  Using the NSQIP-Pediatric, we identified 4070 patients <1-year-old who underwent GT and/or fundoplication from 2012 to 2014. 2346 infants (58%) had CCD categorized as minor, major or severe. Regression models were used to estimate the association of CCD with morbidity/mortality.
  
  
  RESULTS
  Among all patients undergoing fundoplication, there were increased odds of morbidity/mortality among CCD patients compared to non-CCD patients (OR 2.15; p < 0.001). Odds of complications decreased when procedures were performed laparoscopically or later in the first year of life. Using GT alone as a reference, fundoplication alone (OR 1.67; p < 0.001) and GT with fundoplication (OR 1.82; p < 0.001) had increased odds of morbidity/mortality among cardiac patients. Increased risk persisted after stratification by severity of CCD and after accounting for surgical approach.
  
  
  CONCLUSIONS
  Fundoplication is associated with increased odds of morbidity/mortality in infants with CCD compared to GT alone. Risks are lower with laparoscopic approach and if surgery is delayed until later in the first year of life. Timing and surgical approach for patients with CCD requires further investigation.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Short
authors.affiliation: Division of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Travers
authors.affiliation: Division of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: McCracken
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wulkan
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Clifton
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA, 30322, USA. mehulvraval@emory.edu.
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
mesh_terms: D015897:Comorbidity; D005260:Female; D018662:Fundoplication / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Congenital cardiac disease; Fundoplication; GERD; Gastrostomy; NSQIP-P