Anthony J Hesketh, MD, PhD, Jie Yang, PhD, Chencan Zhu, MS, Mark A Talamini, MD, Aurora D Pryor, MD. Stony Brook Medicine
INTRODUCTION: Persistent gastroesophageal reflux disease is one of the most frequent indications for abdominal surgery in children, usually in the form of Nissen fundoplication. While outcomes of anti-reflux procedures have been well described in young children and adults, few studies have focused on the adolescent population. The aim of this study is to examine complications, 30-day readmission rates and rates of reoperation in adolescents who have undergone anti-reflux procedures.
METHODS AND PROCEDURES: With institutional review board approval, the New York Statewide Planning and Research Cooperative System database was queried for patients ages 12-17 with ICD-9 procedural codes for anti-reflux procedures between 1995 and 2010. Patients with diagnostic codes for esophageal reflux, esophagitis or hiatal hernia were included; diagnoses of esophageal malignancy, achalasia or obstructed/gangrenous diaphragmatic hernia were excluded. Patient demographics, comorbidities, and complications were identified. 30-day readmission rates and redo anti-reflux procedures were determined from revisit records through 2014. Chi-square tests were utilized to examine the marginal association between categorical variables and having reoperation/30-day readmission.
RESULTS: Five hundred-six adolescents underwent anti-reflux procedures between 1995 and 2010. One patient died and was excluded from further analysis. Patients were mostly male (60.8%), white (65.0%) and insured privately (66.7%). Most (63.4%) patients had at least one comorbidity, including paralysis (30.5%), neurologic disorders (30.7%), and chronic pulmonary disease (23.2%). Sixty-two patients (12.3%) were readmitted within 30 days. Patients’ race (p<0.005), geographic region (p<0.0005) and insurance status (p<0.01) were significantly associated with 30-day readmission. The presence of any comorbidity was predictive of 30-day readmission (p<0.0001), including paralysis (p=0.001) or other neurological disorders (p<0.0001), obesity (p<0.05) and deficiency anemia (p<0.005). Similarly, the presence of any complication was associated with 30-day readmission (p<0.0001), including reoperation for hemorrhage (p<0.05), intestinal complications (p<0.0001), bacterial infection (p=0.0001), respiratory complications (p<0.0001) and cardiac arrest (p<0.01). Twenty-five patients (5.0%) underwent repeat anti-reflux procedures, with a mean time to reoperation of 706.8 (SD 632.8) days. The only identified risk factor for reoperation was the presence of a coagulopathy (p<0.05).
CONCLUSIONS: Demographics play a substantial role in the outcomes of adolescents undergoing anti-reflux procedures. These patients have a high incidence of comorbid conditions and complications which are associated with readmission. Failure of anti-reflux procedures necessitating eventual reoperation occurs in a considerable number of patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88076
Program Number: P459
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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