腹腔镜治疗先天性肥厚性幽门狭窄,减少了患有肥厚性幽门狭窄的儿童的术后住院时间

Laparoscopic pyloromyotomy decreases postoperative length of stay in children with hypertrophic pyloric stenosis

Abstract
OBJECTIVE:
To determine the impact of laparoscopic versus open pyloromyotomy on postoperative length of stay (LOS).

MATERIALS AND 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.

KEYWORDS:
ACS NSQIP pediatric; Laparoscopic procedure; Pediatrics; Postoperative length of stay; Pyloromyotomy

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