The 2013 National Surgical Quality Improvement Project Pediatric database was queried for all cases of pyloromyotomy performed on children < 1 year old with congenital hypertrophic pyloric stenosis. Demographics, clinical, and perioperative characteristics for patients with and without a prolonged postoperative LOS, defined as > 1 day, were compared. Logistic regression modeling was performed to identify factors associated with a prolonged postoperative LOS.
Out of 1143 pyloromyotomy patients, 674 (59%) underwent a laparoscopic procedure. Patients undergoing open pyloromyotomy had a longer operative time (median 28 vs. 25 min, p < 0.001) but shorter duration of general anesthesia (median 72 vs. 78 min, 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 > 1 day 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 100 g 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 5 min, 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).
Compared to laparoscopic pyloromyotomy, open pyloromyotomy is independently associated with a higher likelihood of a prolonged postoperative LOS.