Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2326-2333 (doi:10.1542/10.1542/peds.2006-2212)
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ARTICLE

Do Antireflux Operations Decrease the Rate of Reflux-Related Hospitalizations in Children?

Adam B. Goldin, MD, MPHa,b, Robert Sawin, MDa,b, Kristy D. Seidel, MSc and David R. Flum, MD, MPHb

a Division of Pediatric General and Thoracic Surgery
c Office of Biostatistical Services, Children’s Hospital and Regional Medical Center, Seattle, Washington
b Department of Surgery, University of Washington Medical Center, Seattle, Washington

OBJECTIVE. Gastroesophageal reflux disease is extremely common in the pediatric population, and antireflux procedures are performed with increasing frequency. The objective of this study was to determine whether pediatric antireflux procedures are associated with a decreased rate of reflux-related hospitalizations.

METHODS. A study was conducted of pediatric patients who were undergoing antireflux procedures using data that were derived from the Washington State Comprehensive Hospital Abstract Reporting System and Vital Records. Patients were identified by a search of all records (1987–2001) for procedure codes that pertained to antireflux procedures in patients who were younger than 19 years. The number of hospitalizations for and rates of reflux-related events per patient-year before and after an antireflux procedure was calculated, and factors that were associated with higher antireflux procedure rates were examined.

RESULTS. A total of 1142 patients underwent antireflux procedures. The rate of reflux-related events declined sharply with age both before and after an antireflux procedure. The cohort was divided into 3 groups on the basis of age at first antireflux procedure (<1 year, 1–3 years, or 4–19 years), and the calculations of incidence rate ratios before to after an antireflux procedure were done within the same age strata. Results suggest an overall benefit of antireflux procedures in young children. For antireflux procedures that were performed in children who were older than 4 years, the benefit is less clear. Developmental delay was significantly associated with higher rates of reflux-related events among patients who underwent an antireflux procedure after age 4.

CONCLUSIONS. The rate of reflux-related events was lower after an antireflux operation for children who underwent an antireflux procedure before age 4. Older children, however, were hospitalized at equal rates before and after an antireflux procedure, and older children with developmental delay were hospitalized at greater rates after an antireflux procedure. These findings highlight the need to clarify the subjective and objective indications for antireflux procedures in infants and children.

Key Words: antireflux surgery • Nissen fundoplication • gastroesophageal reflux • aspiration pneumonia • medical error • quality

Abbreviations: GERD—gastroesophageal reflux disease • ARP—antireflux procedure • RRE—reflux-related event • CHARS—Washington State Comprehensive Hospital Abstract Reporting System • ICD-9—International Classification of Diseases, Ninth Revision • IRR—incidence rate ratio • CI—confidence interval

Accepted Aug 21, 2006.


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