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Research: Benchmarking utilization, length of stay, and complications following minimally invasive repair of major congenital anomalies

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Research: Benchmarking utilization, length of stay, and complications following minimally invasive repair of major congenital anomalies

Surg Endosc

. 2021 Mar 10. doi: 10.1007/s00464-021-08413-1. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/33689012/

Benchmarking utilization, length of stay, and complications following minimally invasive repair of major congenital anomalies

Jordan C Apfeld 1 2Yuri V SebastiΓ£o 1 2Katherine J Deans 1 2 3Peter C Minneci 4 5 6Affiliations expand

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Abstract

Introduction: Infants with newborn congenital anomalies are increasingly undergoing minimally invasive surgical (MIS) repair. Currently available data on outcomes are limited. This study provides national estimates for length of stay and 30-day complications following MIS for congenital anomalies.

Methods: Using the ACS-NSQIP Pediatric (2013-2018), a retrospective analysis of MIS for congenital anomalies was performed. MIS repairs for the following diagnoses were included: pyloric stenosis (PS), congenital lung lesion (LL), mediastinal mass (MM), congenital malrotation (CM), anorectal malformation (ARM), Hirschsprung’s disease (HD), congenital diaphragmatic hernia (CDH), tracheoesophageal fistula (TEF), biliary atresia/choledochal cyst (HB), and intestinal atresia (IA). Postoperative LOS (pLOS) and complication rates were examined using multivariable analysis for risk factors after categorizing surgeries by complexity of care related to congenital anomaly: Simple (PS), Complex Group 1 (LL, MM, CM, and ARM), and Complex Group 2 (HD, CDH, TEF, HB, and IA).

Results: Across 10 anomalies, 8,326 repairs were performed using an MIS approach. Procedure-specific median postoperative LOS (75th-percentile, 90th-percentile) for PS was 1 day (1, 3); LL was 3 (4, 7); MM was 2 (3, 5); CM was 4 (7, 14); ARM was 3 (5, 8); HD was 5 (8, 12); CDH was 8 (18, 31); HB was 5 (8, 12); TEF was 20 (31, 53); and IA was 17 (25, 40). The overall surgical complication rates (95% CI) were: PS, 5.1% (4.7%-5.6%); LL, 14.2% (12.3-16.4); MM, 8.4% (6.4-11.0); CM, 14.6% (11.9-17.9); ARM, 12.0% (7.1-19.5); HD, 22.1% (19.5-25.0); CDH, 21.1% (17.1-25.6); HB, 20.6% (13.7-29.7); TEF, 36% (27.5-45.5); and IA, 28.6% (19.3-40.1). Risk factors for increased pLOS and complications varied by procedure category and included patient-level and admission characteristics.

Conclusion: This study provides national benchmarks and risk factors for expected postoperative LOS and 30-day complications following MIS for congenital anomalies.

Keywords: Congenital anomaly; Laparoscopy; Minimally invasive surgery; Pediatric surgery.

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