Milford Karen, Numanoglu Alp, Sultan Tamer Ali, Klopper Juan, Cox Sharon
Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Division of Paediatric Surgery, Department of General Surgery, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt.
Pediatr Surg Int. 2019 Apr;35(4):501-507. doi: 10.1007/s00383-018-04429-2. Epub 2018 Dec 17.
Nissen fundoplication (NF) is commonly performed in children with gastro-esophageal reflux disease (GERD). Patients undergoing NF often have co-morbidities. Reported outcomes of NF vary considerably. This study investigated which factors might predict multiple readmissions or death in the first year following NF at our institution.
A retrospective chart review of 187 children who underwent NF at our institution between January 2004 and December 2015 was undertaken. Underlying medical conditions, age, weight, presence of malnutrition, length of hospital stay prior to surgery and type of surgery were recorded. Patients who had more than one admission in the first post-operative year were compared to those who had one or none, and patients who died within the first post-operative year were compared to those who did not.
Risk factors for multiple readmissions were underlying cardiac disease (p = 0.011), esophageal atresia (EA) (p = 0.011), and esophageal stricture (p = 0.0002). Risk factors for death included younger age (p = 0.028), need for gastrostomy tube (GT) (p = 0.01) and prolonged pre-operative hospital admission (p = 0.0003).
This study identified multiple factors associated with readmission and death in the first year after NF. These findings will help with the counseling patients and caregivers regarding expectations following NF.
nissen胃底折叠术（NF）常用于治疗胃食管反流病（GERD）患儿。接受NF手术的患者常伴有其他疾病。报道的NF手术结果差异很大。本研究调查了在我们机构进行NF手术后的第一年，哪些因素可能预测多次再入院或死亡。
对2004年1月至2015年12月在我们机构接受NF手术的187例儿童进行回顾性病历审查。记录基础疾病、年龄、体重、营养不良情况、手术前住院时间和手术类型。将术后第一年有多次入院的患者与有一次或无入院的患者进行比较，将术后第一年内死亡的患者与未死亡的患者进行比较。
多次再入院的危险因素包括基础心脏病（p = 0.011）、食管闭锁（EA）（p = 0.011）和食管狭窄（p = 0.0002）。死亡的危险因素包括年龄较小（p = 0.028）、需要胃造瘘管（GT）（p = 0.01）和术前住院时间延长（p = 0.0003）。
本研究确定了与NF术后第一年再入院和死亡相关的多个因素。这些发现将有助于向患者和护理人员提供有关NF术后预期的咨询。
