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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1342-1347

Does Pediatric Surgical Specialty Training Affect Outcome After Ramstedt Pyloromyotomy? A Population-Based Study

Jacob C. Langer, MD*,{ddagger},§ and Teresa To, PhD*,§,||

* Population Health Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
{ddagger} Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
§ Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
|| the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

Objective. Ramstedt pyloromyotomy is a common operation in infants and is often done by general surgeons. We wished to determine whether there are any differences in outcome when this procedure is done by subspecialist pediatric general surgeons as compared with general surgeons.

Methods. All Ramstedt pyloromyotomies in the province of Ontario between 1993 and 2000 were reviewed. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons, specifically examining hospital stay and complications.

Results. Of 1777 eligible infants, 67.9% were operated on by pediatric surgeons and 32.1% by general surgeons. Total and postoperative lengths of stay were longer in the general surgeon group compared with the pediatric surgeons (4.31 vs 3.50 days for length of stay; 2.95 vs 2.25 days for postoperative length of stay). The general surgeons had a higher overall complication rate (4.18% vs 2.58%). The incidence of duodenal perforation among general surgeons was almost 4 times that of pediatric surgeons (relative risk: 3.65; 95% confidence interval: 1.43-9.32). Of the 4 infants who required repeat surgery because of an incomplete pyloromyotomy, all were originally operated on by a general surgeon. Analysis of the effect of surgeon volume on outcomes suggested that higher volume resulted in better outcome in both groups.

Conclusion. Subspecialist pediatric general surgeons achieve superior outcomes for children who undergo Ramstedt pyloromyotomy.

Key Words: pyloric stenosis • subspecialization • patient volume • pediatric surgery • general surgery • outcomes analysis

Abbreviations: GS, general surgeon • CIHI, Canadian Institute for Health Information • ICD-9, International Classification of Diseases Ninth Revision • PGS, pediatric general surgeon • LOS, length of stay

Received for publication May 22, 2003; Accepted Sep 15, 2003.




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