M. Joseph1, E. Hamilton1, K. Tsao1, M. T. Austin1,2 1McGovern Medical School At The University Of Texas Health Science Center At Houston,Pediatric Surgery,Houston, TX, USA 2University Of Texas MD Anderson Cancer Center,Surgical Oncology,Houston, TX, USA
Introduction: Hypertrophic pyloric stenosis (HPS) is a common surgical problem in infants and pyloromyotomy is the curative treatment of choice in this population. Hospitalizations following pyloromyotomy for HPS are usually short, often less than one day. Recent research has focused on evaluating the presence of health disparities in children and their impact on clinical outcomes. The purpose of this study was to evaluate the association sociodemographic and hospital factors with post-operative length of stay (LOS) in patients with HPS.
Methods: We identified all patients age < 1 year old hospitalized with a primary diagnosis of HPS in 2006, 2009 and 2012 using the Health Care Utilization Project-Kids Inpatient Database. We included all patients who received an open or laparoscopic pyloromyotomy during the hospital admission. Patient demographics, hospital characteristics and clinical outcomes were collected. All patients with secondary procedures during the same admission were excluded. Prolonged post-operative length of stay (LOS) was defined as greater than 1 day. Neonatal age is defined as <= 28 days in the KIDS database. Binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals using SPSS version 24.
Results: A total of 12,401 cases were identified with a diagnosis of HPS. Most (n=7387, 60%) were non-Hispanic White (NHW) followed by Hispanic (n=3159, 26%), non-Hispanic Black (NHB) (n=923, 7%) and Other (n=932, 7%). The majority had public insurance (n=7551, 61%) followed by private insurance (n=4076 33%) with only 3% uninsured/self-pay. The median post-operative length of stay was 1.00 + 0.93 days. By multivariate analysis, the presence of fluid/ electrolyte disorders (OR=1.56, 95%CI:1.41-1.72), neonatal age (OR=1.38, 95%CI:1.26-1.51), NHB and Other race/ethnicity (OR=1.34, 95%CI: 1.15-1.62; OR=1.32, 95%CI:1.12-1.55, respectively), and rural hospital location (OR= 1.67, 95%CI:1.29-2.16) were all independently associated with prolonged post-operative LOS. Compared to the North, all hospital regions were associated with decreased post-operative LOS: Midwest (OR= 0.72, 95% CI: 0.63-0.82), South (OR= 0.87, 95% CI: 0.77-0.99) and West (OR= 0.83, 95% CI: 0.72-0.94). Insurance status and zip-code based income quartile were not statistically significant predictors of prolonged post-operative LOS.
Conclusion: NHB and Other race/ethnicity were independently associated with prolonged post-operative LOS following pyloromytomy for HPS. Other hospital-related factors were important including rural versus urban location and geographic region. Further research is needed to better describe and address disparities in the clinical management and outcome of children with HPS.