C. M. Kelleher1,2, P. T. Masiakos1,2, D. C. Chang2,3 1Massachusetts General Hospital,Pediatric Surgery,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA 3Massachusetts General Hospital,Surgery,Boston, MA, USA
Introduction: Pyloromyotomy for hypertrophic pyloric stenosis is considered a safe pediatric surgical procedure with few complications or readmissions. Although the incidence of complications has been reported, the rate of readmissions on a population level is unknown.
Methods: Data was abstracted from the longitudinally linked Office of Statewide Health Planning and Development data from the State of California from 1995 to 2009, which allows patient tracking across all hospitals and across all years within California. Inclusion criteria were primary procedure code of pyloromyotomy, a diagnosis code of hypertrophic pyloric stenosis, and no prior record of any in-hospital admission.
Results: A total of 1900 patients were identified (16.8% girls, 31.7% whites, 5.1% blacks, and 58.2% Hispanics). 3.53% of the patients were found to have a significant congenital or comorbid condition; another 0.84% of patients were born prematurely. The median length of stay was 2 days (IQR 2-3 days). The in-hospital complication rate was 5.16%; There were no deaths. The rate of 30-day all-cause readmission was 4.01%, with a median of 0% across hospitals (IQR 0%-1.1%); and 13.2% of readmissions occurred at a different hospital. Surgically-related readmission rate was 2.16%. All-cause readmissions at 60 days, 90 days, 180 days, and 1 year were 5.8%, 7.3%, 10.4%, and 13.7%, respectively. The top three primary diagnoses on readmission were hypovolemia, upper respiratory infections, and post-operative infections.
Conclusion: Thirty day readmission for a surgical complication occurs in 1 of 50 patients undergoing a pyloromyotomy for hypertrophic pyloric stenosis and for all causes is 1 in 25 patients. This data can help inform physicians, families and policy makers about rates of hospital readmission in this common pediatric surgical procedure.