M. Cunningham1, C. T. Hoch1, A. M. Vogel1, B. Naik-Mathuria1, S. R. Shah1 1Texas Children’s Hospital,Division Of Pediatric Surgery, Baylor College Of Medicine,Houston, TX, USA
Introduction: Hypertrophic pyloric stenosis (HPS) is a common surgical condition of infancy. The impact of varying inpatient levels of care on outcomes and cost for HPS patients is unknown. The purpose of this study is to assess outcomes and cost of care for HPS patients admitted primarily to either the neonatal intensive care unit (NICU) or the floor.
Methods: A retrospective chart review was performed for infants who underwent pyloromyotomy for HPS from 12/2011-3/2018. Patients were excluded if they had significant comorbidities, were mechanically ventilated, <37 weeks gestational age at presentation, transferred between units, or had not left the hospital since birth. Descriptive statistics were performed using chi square, Fisher’s exact, and Mann-Whitney. A value of p<0.05 was considered significant.
Results:There were 375 infants included in the study, of which 86% were male with a median age of 4.7 [3.4-6.4] weeks. There were 211 admitted to the floor and 164 to the NICU. NICU patients were slightly younger (4.3 [3.0-5.9] vs 5.0 [3.7-6.6] weeks; p=0.002); otherwise, the groups were similar regarding symptom length (7 [3-14] vs 7 [4-14] days), family history (9% vs 8%), laparoscopic approach (71% vs 72%), time to surgery (18 [13-24] vs 20 [14-27] hours) and time to post-operative feeds (7.8 [4.7-11.3] vs 9.3 [5.1-15.5] hours). Complications (surgical site infection, abscess, mucosal perforation, and incomplete pyloromyotomy) were similar among groups, with overall complication rate of 3.5%. Postoperative and total hospital lengths of stay were longer for NICU patients (26 [22-32] vs 29 [23-46] hours; p<0.001) and (46 [40-64] vs 48 [42-69] hours; p=0.016). Cost of care was also higher for NICU patients (Table 1).
Conclusion:
Floor admission for infants with hypertrophic pyloric stenosis without major comorbidity leads to less cost than NICU admission, without compromise in safety or outcomes.
