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Adam B. Goldin, MD, MPH; Michelle Garrison, PhD; Dimitri Christakis, MD, MPH

Arch Pediatr Adolesc Med. 2009;163(7):658-663.

Objective  To examine the differences and trends in pediatric antireflux procedures (ARPs) across individual pediatric hospitals over time.

Design  Retrospective cohort study.

Setting  Administrative database containing inpatient records with discharge dates between January 1, 2001, and March 31, 2006.

Participants  Hospitalized pediatric patients younger than 18 years with primary procedure codes for ARP, appendectomy, pyloromyotomy, and gastrostomy tube placement. The comparisons with admissions for these common procedures were used to identify changes in the incidence of ARP per hospital per year.

Main Outcome Measures  The ratio of ARPs to appendectomies, pyloromyotomies, gastrostomies, and all 3 procedures combined, in each hospital by year.

Results  During our study period 13 691 ARPs, 41 441 nonincidental appendectomies, 14 895 pyloromyotomies, and 23 527 gastrostomy tube placements were identified. The average number of ARPs per appendectomy, pyloromyotomy, and gastrostomy tube placement declined annually across free-standing pediatric institutions. When these annual changes are examined within each hospital individually, however, it appears that such changes are not occurring equally, in that some hospitals are performing significantly greater and some significantly fewer ARPs relative to these common procedures.

Conclusions  The number of ARPs being performed in 36 free-standing children's hospitals is decreasing each year relative to several operations commonly performed at these institutions. Despite this overall annual decrease, there is tremendous variation between individual hospitals in how frequently ARPs are being performed relative to these procedures.

Author Affiliations: Department of General and Thoracic Surgery, Seattle Children's Hospital (Dr Goldin); Child Health Institute, University of Washington (Dr Garrison); and the Center for Child Health, Behavior, and Development, Seattle Children's Hospital Research Institute, Seattle, Washington (Drs Garrison and Christakis).

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