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SPA Newsletter

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Volume 17 Number 3
Summer 2004 Newsletter
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Does pediatric surgical specialty training affect outcome after Ramstedt Pyloromyotomy? A population-based study.

Langer J, To T. Pediatrics 2004;113:1342-1347

The authors of this paper reviewed all Ranstedt pyloromyotomies done in Ontario between the dates of 1993 and 2000, excluding children with complex medical conditions. There were 1,777 eligible infants and 141 infants who were excluded from prematurity or other medical conditions. Cases done by general surgeons were compared to those done by pediatric surgeons.

Outcome measures included length of hospital stay and the incidence of complications. Data was obtained from a computerized system from the Canadian Institute for Health Information (CIHI). All hospitals in Canada are required to collect discharge data on all patients.

Of the eligible infants, 68% had procedures done by pediatric surgeons leaving 32% who were operated on by general surgeons. Cases done by pediatric surgeons had shorter total hospital stay (3.5 vs. 4.3 days), and postop hospital stay (2.25 vs. 2.95 days). Post-operative complications noted included; postoperative shock, hemorrhage or hematoma, disruption of the surgical wound, postoperative infection, duodenal perforation, postoperative fistula.

Pediatric surgeons had a lower rate of complications (2.6% vs. 4.2%). Duodenal perforation was seen nearly four times as often in cases done by general surgeons than in cases of pediatric surgeons. All four patients who required re-operation wee done by general surgeons.

Commentary

The authors are quick to point out that the database used in the this review was created for administration of the health care system, not research and that the possibility that there are differences in reporting among different surgeons and hospitals may have affected the accuracy of the data. Nevertheless, the relationship noted between volume of cases done and lower complication rates noted by the authors is compelling. I can't help but wonder if the differences seen, particularly in the shorter postoperative length of stay in specialist cases might have been influenced by the perioperative care given by a pediatric anesthesiologist as opposed to a general anesthesiologist. Perhaps a pediatric anesthesiologist in Canada will use this excellent database to make the case that perioperative care of children, when given by a pediatric anesthesiologist as opposed to a general anesthesiologist, is associated with fewer complications.

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