PT  - JOURNAL ARTICLE
AU  - Alexander C. Ednie
AU  - Ofer Amram
AU  - Jenna Colleen Creaser
AU  - Nadine Schuurman
AU  - Suzanne Leclerc
AU  - Natalie Yanchar
TI  - Hypertrophic pyloric stenosis in the Maritimes: examining the waves of change over time
AID  - 10.1503/cjs.002816
DP  - 2016 Dec 01
TA  - Canadian Journal of Surgery
PG  - 383--390
VI  - 59
IP  - 6
4099  - http://canjsurg.ca/content/59/6/383.short
4100  - http://canjsurg.ca/content/59/6/383.full
SO  - CAN J SURG2016 Dec 01; 59
AB  - Background: Changing patterns of referral and management of pediatric surgical conditions, including hypertrophic pyloric stenosis (HPS), have recently been described and often relate to comfort with early nonoperative management, anesthesia and corrective surgery. Travelling distance required for treatment at pediatric centres can also be burdensome for families. We assessed referral patterns for HPS in the maritime provinces of Canada over 10 years to quantify the burden on families travelling for surgical care.Methods: We reviewed the charts of all patients with HPS in the Maritimes. Length of hospital stay (LOS) and complication rates were analyzed in regards to resuscitation and management at a pediatric centre and/or peripheral centres. We used postal codes for each patient to track distance travelled for management.Results: We assessed 751 cases of HPS. During the study period (Jan. 1, 2001–Dec. 31, 2010), referral to pediatric centres increased from 49% to 71%. Postoperative complications were 2.5-fold higher in peripheral centres. Infants referred to pediatric centres were 78% less likely to have an LOS longer than 3 days. Laparoscopic pyloromyotomy, which was performed only in pediatric centres, was associated with a shorter postoperative LOS.Conclusion: Our study supports the current literature demonstrating improved outcomes, shorter overall LOS and decreased risk of complications when infants with HPS are treated in pediatric centres. This should be considered when planning access to pediatric surgical resources.