Reflux Related Hospital Admissions after Fundoplication in Children with Neurological Impairment: Retrospective Cohort Study

Abstract

Objective: To examine the impact of fundoplication on reflux related hospital admissions for children with neurological impairment. Design: Retrospective, observational cohort study. Setting: 42 children’s hospitals in the United States. Participants: 3,721 children with neurological impairment born between 2000 and 2005 who had at least one hospital admission at a study hospital before their fundoplication. Intervention: Fundoplication. Main outcome measures: Incident rate ratio for reflux related hospital admissions, defined as the post-fundoplication admission rate divided by the pre-fundoplication admission rate. Results: Of the 955,285 children born during the study period, 144,749 (15%) had neurological impairment. Of these, 27,720 (19%) were diagnosed as having gastro-oesophageal reflux disease, of whom 6,716 (24%) had a fundoplication. Of these, 3,721 (55%) had at least one previous hospital admission and were included in the study cohort. After fundoplication, hospital admissions decreased for any reflux related cause (incident rate ratio 0.69, 95% confidence interval 0.67 to 0.72; P<0.01), aspiration pneumonia (0.71, 0.62 to 0.81; P<0.01), gastro-oesophageal reflux disease (0.60, 0.57 to 0.63; P<0.01), and mechanical ventilation (0.40, 0.37 to 0.43; P<0.01), after adjustment for other patient and hospital related factors that may influence reflux related hospital admissions. Hospital admissions increased for asthma (incident rate ratio 1.52, 1.38 to 1.67; P<0.01) and remained constant for pneumonia (1.07, 0.98 to 1.17; P=0.16). Conclusions: Children with neurological impairment who have fundoplication had reduced short term reflux related hospital admissions for aspiration pneumonia, gastro-oesophageal reflux disease, and mechanical ventilation. However, admissions for pneumonia remained constant and those for asthma increased after fundoplication. Comparative effectiveness data for other treatments (such as gastrojejunal feeding tubes) are unknown.