Elsevier

Journal of Pediatric Surgery

Volume 51, Issue 11, November 2016, Pages 1755-1758
Journal of Pediatric Surgery

Original Article
Operative outcomes of infantile hypertrophic pyloric stenosis in patients with congenital heart disease

https://doi.org/10.1016/j.jpedsurg.2016.07.002Get rights and content

Abstract

Purpose

This study aims to compare the outcomes of pyloromyotomy for infantile hypertrophic pyloric stenosis (IHPS) in children with and without congenital heart disease (CHD).

Methods

A retrospective, single pediatric center, case–control, matched cohort study was performed over 10 years. A case of IHPS with CHD was paired with control patients of IHPS without CHD, matched by age and gender. Perioperative morbidity, 30-day mortality, length of hospital stay, and hospital cost were compared. Subgroups were analyzed based on the severity of CHD and the reason for admission.

Results

Twenty-six patients who underwent pyloromyotomy for IHPS with CHD (CHD group) were matched with 78 patients with IHPS without CHD (Non-CHD group). No 30-day mortality was identified in either group. Overall perioperative complications were not significantly different between groups (11.5% vs 5.2%, p = 0.163). However, postoperative length of stay was longer in CHD group (6 vs 1 days, p < 0.001) and any subgroups of CHD as compared to Non-CHD group. CHD group patients admitted only for IHPS had short postoperative LOS, whereas those who developed pyloric stenosis during a hospital admission stayed longer postoperatively (1.5 vs 26.5 days, p < 0.001).

Mean hospital costs in patients admitted for IHPS were $16,270 and $3591 for CHD group and Non-CHD group, respectively (p < 0.001).

Conclusions

IHPS patients with CHD have prolonged postpyloromyotomy course, especially when inpatients with CHD incidentally develop IHPS.

Section snippets

Materials and methods

This is a retrospective, single pediatric center, matched case–control study to evaluate the perioperative morbidity and mortality in patients with CHD and IHPS who underwent laparoscopic or open pyloromyotomy during the study period 2005–2014. Patients with both IHPS and CHD were identified by ICD-9 codes within our patient care database systems. A case of IHPS with CHD was randomly paired with three control patients of IHPS without CHD, matched by postnatal age and gender. Fourteen days of

Results

Twenty-six patients who underwent pyloromyotomy for IHPS in patients with CHD were identified (CHD group). As a result of 1:3 matching, 78 patients with IHPS without CHD (Non-CHD group) were paired with each study patient (Fig. 1).

The clinical characteristics between CHD and Non-CHD groups are shown in Table 2. No 30-day mortality or intraoperative morbidity was identified in either group (Table 3). While mucosal perforation was more common in CHD group (11.5% vs 0%, p = 0.014), the difference in

Discussion

Although our results showed that CHD patients have slightly higher risk of mucosal perforation, the difference between CHD and Non-CHD groups in overall perioperative risk did not reach statistical significance. However, LOS was longer in CHD groups regardless of CHD category. Notably, when inpatients with CHD incidentally developed IHPS, their postoperative LOS from pyloromyotomy was significantly longer. While the longer LOS and higher cost in these patients are almost certainly attributable

Conclusions

Pyloromyotomy for IHPS in patients with CHD is associated with longer hospital stay and increased cost, especially when the patients are already hospitalized for non-IHPS reasons.

References (21)

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    Earlier recognition of HPS with the aid of ultrasound technology has reduced the incidence of presentation with severe electrolyte disturbances, reducing perioperative morbidity. Vulnerable populations such as premature infants and those with cardiac conditions have been shown to have increased morbidity and postoperative length of stay82,83. Notably, mortality rates have been reported to be higher in the developing world, as high as 4.9% in one publication from Tanzania.

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    Postoperative LOS was also associated with preoperative hospital LOS exceeding 14 days, the presence of moderate ventricular dysfunction, and the preoperative use of inotropes.16 A matched cohort study of children with hypertrophic pyloric stenosis with and without CHD highlighted the additional costs incurred (largely due to length of stay) in children with CHD.35 However, the length of stay was dramatically impacted by the preceding length of admission suggesting that the diagnosis of pyloric stenosis may not have been the driving factor for the length of stay.

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  • Nationwide trends of laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis in Germany: A slow path forward

    2023, Frontiers in Pediatrics

  • The safety and effectiveness of laparoscopic versus open surgery for congenital hypertrophic pyloric stenosis in infants

    2020, Medical Science Monitor

  • Predictive factors for time to full enteral feeding after pyloromyotomy for infantile hypertrophic pyloric stenosis

    2020, World Journal of Pediatric Surgery
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1

S.M. and J.C. contributed equally to this study.

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