Laparoscopic pyloromyotomy decreases postoperative length of stay in children with hypertrophic pyloric stenosis

Objective To determine the impact of laparoscopic versus open pyloromyotomy on postoperative length of stay (LOS). Materials and methods The 2013 National Surgical Quality Improvement Project Pediatric database was queried for all cases of pyloromyotomy performed on children < 1 year old with congenital hypertrophic pyloric stenosis. Demographics, clinical, and perioperative characteristics for patients with and without a prolonged postoperative LOS, defined as > 1 day, were compared. Logistic regression modeling was performed to identify factors associated with a prolonged postoperative LOS. Results Out of 1143 pyloromyotomy patients, 674 (59%) underwent a laparoscopic procedure. Patients undergoing open pyloromyotomy had a longer operative time (median 28 vs. 25 min, p < 0.001) but shorter duration of general anesthesia (median 72 vs. 78 min, p < 0.001). Patients undergoing open pyloromyotomy more frequently had a prolonged postoperative LOS (32% vs. 26%, p = 0.019). Factors independently associated with postoperative LOS > 1 day included open pyloromyotomy (odds ratio, 95% confidence interval, p-value) (1.38, 1.03–1.84, p = 0.030), cardiac comorbidity (3.64, 1.45–9.14, p = 0.006), pulmonary comorbidity (3.47, 1.15–10.46, p = 0.027), lower weight (1.005 per 100 g decrease, 1.002–1.007, p < 0.001), longer preoperative LOS (1.35 per additional day, 1.13–1.62, p = 0.001), longer operative time (1.11 per additional 5 min, 1.05–1.17, p < 0.001), higher preoperative blood urea nitrogen (1.04 per additional mg/dl, 1.01–1.07, p = 0.012), and higher serum sodium (1.08 per additional mg/dl, 1.03–1.14, p = 0.004). Conclusions Compared to laparoscopic pyloromyotomy, open pyloromyotomy is independently associated with a higher likelihood of a prolonged postoperative LOS.