Title

Outcomes of laparoscopic and open surgery in children with and without congenital heart disease.

Year of Publication

2017

Number of Pages

1980-1988

Date Published

2018 Oct

ISSN Number

1531-5037

Abstract

<p><strong>BACKGROUND: </strong>Children with congenital heart disease (CHD) often require noncardiac surgery. We compared outcomes following open and laparoscopic intraabdominal surgery among children with and without CHD.</p>

<p><strong>METHODS: </strong>We performed a retrospective cohort study using the 2013-2015 National Surgical Quality Improvement Project-Pediatrics. We matched 45,012 children &lt;18years old who underwent laparoscopic surgery to 45,012 children who underwent open surgery. We determined the associations between laparoscopic (versus open) surgery and 30-day mortality, in-hospital mortality, 30-day morbidity, and postoperative length-of-stay.</p>

<p><strong>RESULTS: </strong>Among children with minor CHD, laparoscopic surgery was associated with lower 30-day mortality (Odds Ratio [OR] 0.34 [95% Confidence Interval 0.15-0.79]), inhospital mortality (OR 0.42 [0.22-0.81]) and 30-day morbidity (OR 0.61 [0.50-0.73]). As CHD severity increased, this benefit of laparoscopic surgery decreased for 30-day morbidity (ptrend=0.01) and in-hospital mortality (ptrend=0.05), but not for 30-day mortality (ptrend=0.27). Length-of-stay was shorter for laparoscopic approaches for children at cost of higher readmissions. On subgroup analysis, laparoscopy was associated with lower odds of postoperative blood transfusion in all children.</p>

<p><strong>CONCLUSIONS: </strong>Intraabdominal laparoscopic surgery compared to open surgery is associated with decreased morbidity in patients with no CHD and lower morbidity and mortality in patients with minor CHD, but not in those with more severe CHD.</p>

<p><strong>LEVEL-OF-EVIDENCE: </strong>Level III: Treatment Study.</p>

DOI

10.1016/j.jpedsurg.2017.10.052

Alternate Title

J. Pediatr. Surg.

PMID

29157923

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