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ABSTRACT: Traditional imaging for ablation of supraventricular tachycardia has been fluoroscopy, although 3-dimensional electroanatomic mapping (3D) has been demonstrated to reduce radiation exposure. This study compares a technique for the reduction of radiation, low-dose fluoroscopy (LD), with standard-dose fluoroscopy (SD) and 3D with SD (3D-SD). This was a single institutional retrospective cohort study. All patients undergoing initial ablation for atrioventricular reentrant tachycardia (AVRT) or atrioventricular nodal reentrant tachycardia (AVNRT) from 2009 to 2012 were reviewed and divided into 3 groups: (1) SD, (2) 3D (CARTO or NavX) with SD, or (3) LD. LD uses the same equipment as SD but includes customized changes to the manufacturer's lowest settings by decreasing the requested dose to the detector. Primary outcomes were fluoroscopy time and dose area product exposure. One hundred eighty-one patients were included. The median age was 15.0 years (3.3-20.8); 59% had AVRT, 35% had AVNRT, and 6% had both AVRT and AVNRT. LD decreased the dose area product (DAP) compared with SD (637.0 vs 960.1 cGy*cm(2), p = 0.01) with no difference in fluoroscopy time. 3D-SD decreased fluoroscopy time compared with SD (9.9 vs 18.3 minutes, p <0.001) with DAP of 570.1.0 versus 960.1 cGy*cm(2) (p = 0.16). LD and 3D-SD had comparable DAP (637.0 vs 570.1 cGy*cm(2), p = 0.67), even though LD had significantly longer fluoroscopy time (19.9 vs 9.9 minutes, p <0.001). In conclusion, LD during catheter ablation of AVRT and AVNRT significantly reduced the DAP compared with SD and had similar radiation exposure compared with 3D with SD.
The American journal of cardiology 04/2013; · 3.58 Impact Factor
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ABSTRACT: Staged surgical palliation has revolutionized the care of patients with hypoplastic left heart syndrome (HLHS), although the outcomes of survival and cost at a national level remain unclear. This study sought to evaluate (1) trends in HLHS surgical outcomes including in-hospital mortality, length of stay (LOS), and cost, and (2) patient and hospital risk factors associated with these outcomes. Hospitalizations for patients with HLHS, including stage I, II, and III palliations, were analyzed using the Kids' Inpatient Database from 2000 through 2009. Trends in mortality, LOS, and cost were analyzed and chi-squared tests were used to test association between categorical variables. Patient and hospital characteristics associated with death were analyzed using logistic regression and associations with LOS were analyzed using ordinary least squared regression. There were 16,923 hospital admissions in patients with HLHS of which 5,672 (34%) included surgical intervention. Total (3,201-5,102) and surgery-specific admissions (1,165-1,618) increased from 2000 to 2009. Mortality decreased 14% per year in stage III palliations (odds ratio [OR] 0.86; 95% confidence interval [CI]: 0.79-0.94) and 6% per year for stage I palliations (OR 0.94; 95% CI 0.90-0.99) but not for stage II palliations (OR 1.01; 95% CI; 0.89-1.14). Length of stay increased for stage I and II palliations; however, per-patient hospital cost decreased in 2009. In conclusion, recent decrease in per patient cost for staged surgical palliation for HLHS has correlated temporally with improved mortality.
The American journal of cardiology 03/2013; · 3.58 Impact Factor
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ABSTRACT: Pallid breath-holding (PBH) is a childhood condition that presents with recurrent syncope. Although typically benign, severe cases can lead to asystole and anoxic seizures. Previous studies have advocated pacemaker placement to abbreviate symptoms. This was a retrospective study of patients treated with fluoxetine for PBH spells. Clinical response, side effects and avoidance of pacemaker implantation were reviewed in six patients (12-60 months) treated with fluoxetine for PBH. Patients were referred because of concern of arrhythmia and failed medical treatment strategies. Two patients had previously implanted loop recorders, 5 patients had documented episodes of asystole, and 2 patients had generalized seizures. Fluoxetine resulted in alleviation of syncope in 5 of 6 patients. Time to symptomatic improvement symptoms ranged from 2 days to 1 month (median, 2 weeks). Median duration of treatment with fluoxetine was 12 months (12-24 months). One patient demonstrated no improvement and had a pacemaker implanted. There were no reported side effects to fluoxetine. Fluoxetine can be used to treat childhood PBH spells and may obviate the need for permanent pacing in a significant subset of this population. Considering its safe side-effect profile it is a worthwhile first-line agent to treat this disorder.
PEDIATRICS 08/2012; 130(3):e685-9. · 4.47 Impact Factor
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ABSTRACT: Postoperative Heart Block in Congenital Heart Disease. Introduction: Cardiac conduction system injury is a cause of postoperative cardiac morbidity following repair of congenital heart disease (CHD). The national occurrence of postoperative complete heart block (CHB) following surgical repair of CHD is unknown. We sought to describe the occurrence of and costs related to postoperative CHB following surgical repair of common forms of CHD using a large national database. Methods and Results: Retrospective, observational analysis performed over a 10-year period (2000-2009) using the Kids' Inpatient Database (KID). Visits for patients ≤24 months of age were identified who underwent surgical repair of ventricular septal defects (VSD), atrioventricular canal defects (AVC), and tetralogy of Fallot (TOF). Patients were identified who were diagnosed with postoperative CHB, further identifying those requiring a new pacemaker placement during the same hospitalization. Costs associated with visits were calculated. There were 16,105 surgical visits: 7,146 VSD, 3,480 AVC, and 5,480 TOF. There was a decrease in postoperative mortality (P = 0.0001) with no significant change in postoperative CHB. Hospital stay and cost were higher with CHB and placement of a permanent pacemaker. Repair of AVC (OR 1.77; [1.32-2.38]) was associated with a higher rate of postoperative CHB. Length of hospital stay and total cost were significantly increased with the development of postoperative CHB and increased further with placement of a permanent pacemaker. Conclusion: There has been little change over time in the frequency of postoperative CHB in patients undergoing repair of VSD, AVC, and TOF. Postoperative CHB results in major added cost to the healthcare system. (J Cardiovasc Electrophysiol, Vol. pp. 1-6).
Journal of Cardiovascular Electrophysiology 06/2012; · 3.06 Impact Factor
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ABSTRACT: Symptomatic upper-extremity deep venous thrombosis (UEDVT) after pacemaker placement in adults has been reported, but the occurrence of UEDVT in pediatric patients is poorly defined, and no treatment guidelines exist. This report describes a 14-year old girl with a history of complete atrioventricular block who experienced a symptomatic UEDVT 8 months after placement of a transvenous pacemaker. The girl was treated initially with anticoagulation including subcutaneous enoxaparin and a heparin drip, which did not resolve the venous obstruction. In the interventional laboratory, a venogram demonstrated complete obstruction of the left subclavian vein, which was treated successfully with catheter-directed alteplase, direct thrombus removal by manual suctioning, and balloon angioplasty. Warfarin therapy was continued for an additional 6 months, with follow-up venous ultrasounds demonstrating left subclavian vein patency. Soon after completing warfarin therapy, the girl presented with minimal edema of her left distal extremity and was thought to have post-thrombotic syndrome, which resolved quickly. She continued to receive aspirin therapy, with no recurrence of symptoms. In conclusion, symptomatic UEDVT after pacemaker placement in a pediatric patient can be treated successfully with both anticoagulation and interventional therapies. Further studies are needed to evaluate the incidence of thrombus formation among children with transvenous pacemaker placement together with the development of guidelines based on the safety and effectiveness of differing treatments.
Pediatric Cardiology 05/2012; · 1.30 Impact Factor
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ABSTRACT: Syncope is a common problem in children and adolescents. The diagnostic yield for most tests commonly used in the evaluation of pediatric patients with syncope is low.
To examine the epidemiology of pediatric patients presenting to United States (US) emergency departments (EDs) with a complaint of syncope and compare their initial management to published guidelines.
ED visits from the National Hospital Ambulatory Medical Care Survey for 2003-2007 for patients aged 7-18 years were analyzed. Outcome variables were diagnostic tests and management of patients presenting with syncope.
There were 627,489 (95% confidence interval [CI] 527,237-727,722) ED visits for syncope (0.9% of all ED visits for patients aged 7-18 years). Patients presenting to the ED for syncope were more commonly female (p<0.01), adolescent (13-18 years) (p<0.01), covered by private insurance (p=0.01), and more likely to arrive to the ED by ambulance (p<0.01), compared to those presenting with other complaints. Only 58.1% (95% CI 50.3-66.0%) of syncope patients received an electrocardiogram, and 26.5% (95% CI 18.2-34.7%) received a computed tomography (CT) or magnetic resonance imaging (MRI) scan as part of their diagnostic work-up.
When evaluating pediatric patients presenting with syncope, there should be an increased use of the electrocardiogram to screen for underlying cardiac abnormalities. There should also be a tempered use of CT/ MRI imaging in this population.
Journal of Emergency Medicine 03/2012; 43(4):575-83. · 1.31 Impact Factor
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ABSTRACT: Syncope is common in children and adolescents and most commonly represents neurocardiogenic syncope. No information has been reported regarding the effect of syncope on health-related quality of life in children.
This was a retrospective cohort study of patients seen in the Heart Institute Syncope Clinic at Cincinnati Children's Hospital Medical Center between July, 2009 and June, 2010. Health-related quality of life was assessed using the PedsQL™ tool. PedsQL™ scores were compared with both healthy historical controls and historical controls with chronic illnesses.
A total of 106 patients were included for analysis. In all, 90% were Caucasian and 63% were girls. The median age was 15.1 years (8.2-21.6). Compared with healthy controls, patients had lower PedsQL™ scores: Total score (75.2 versus 83.8, p < 0.0001); Physical Health Summary (78.8 versus 87.5, p < 0.0001); Psychosocial Health Summary (73.9 versus 81.9, p < 0.001), Emotional Functioning (68.9 versus 79.3, p < 0.001); and School Functioning (66.4 versus 81.1, p < 0.001). No difference was seen in Social Functioning (86.2 versus 85.2, p = 0.81). Patients also had lower PedsQL™ Total scores than patients with diabetes mellitus (p < 0.0001) and similar scores to patients with asthma, end-stage renal disease, obesity, and structural heart disease. Conclusion Children with syncope, although typically benign in aetiology, can have low health-related quality of life.
Cardiology in the Young 02/2012; 22(5):583-8. · 0.76 Impact Factor
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ABSTRACT: Cardiac rhythm devices are important in the management of pediatric patients with rhythm abnormalities, although factors driving utilization are poorly understood.
This study sought to evaluate utilization trends, complication rates, and cost associated with device implantation in the pediatric population.
Device implantation was analyzed using the Kids' Inpatient Database from 1997 to 2006. The type of device implantation, patient demographics, hospital characteristics, acute in-hospital complications, cost, and length of stay (LOS) were analyzed. χ(2) tests were used to test association between categorical variables, and logistic regression analysis was performed to evaluate risk factors associated with complications.
There were 5788 hospitalizations with device implantations. Although there was a significant increase in defibrillator implantation, there was no significant increase in the number of pacemaker implantations over this time period. Patient- and device-related complications were relatively common in all device cohorts (pacemaker 11.2%, 7.2%; defibrillator 5.9%, 11.5%; and biventricular device 19.4%, 26.7%). Type of complication was dependent on device type. Increased risk of complication was evident in the pacemaker cohort, patients with congenital heart disease, cardiomyopathy, previous cardiac arrest, and other heart operations. Patient-related complications increased cost and LOS regardless of patient or procedural characteristics. Device implantation in patients <5 years old was associated with increased LOS and cost but was not associated with increased risk of complication.
Device utilization in pediatrics is increasing due to escalating defibrillator implantation and biventricular pacing. Cost and LOS are significantly increased by patient complications. Reduction in these complications would improve patient care and lower medical costs.
Heart rhythm: the official journal of the Heart Rhythm Society 09/2011; 9(2):199-208. · 4.56 Impact Factor
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ABSTRACT: Individuals with ventricular preexcitation (VP) are known to have an increased risk of sudden death. This risk has been associated with conduction properties of the accessory pathway.
Patients with VP underwent risk stratification through the use of exercise and transesophageal testing. All patients were initially screened with exercise testing and those with preexcitation throughout exercise went on to have transesophageal testing. Patients who demonstrated high-risk pathway characteristics by transesophageal testing or developed clinical indications for an electrophysiology (EP) study underwent ablation. This stepwise risk stratification technique was evaluated for the ability to avoid the need for intracardiac EP study. Patients stratified as low risk were contacted for follow-up.
One hundred and twenty-nine exercise studies were performed in 127 patients. Thirty-five of 129 exercise studies demonstrated accessory pathway block during exercise. Twenty-seven of 35 underwent no additional testing. Sixty-six patients underwent transesophageal testing. Forty-nine of 66 patients demonstrated low-risk pathway characteristics and 40 of 49 underwent no further testing. In total, 68 of 129 (53%) patients avoided the need for intracardiac EP study and ablation. A noncardiac indication for the initial diagnostic electrocardiogram was associated with lower likelihood of intracardiac EP study. None of the patients stratified as low risk had additional invasive procedures or life-threatening arrhythmias upon follow-up.
Successful risk stratification of pediatric patients with VP is possible through the use of exercise and transesophageal testing. In this patient population, half of the patients were able to avoid an intracardiac EP study.
Pacing and Clinical Electrophysiology 05/2011; 34(5):555-62. · 1.35 Impact Factor
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ABSTRACT: Poor growth is common in infants with a single ventricle. Lower weight-for-age z-score (WAZ) is associated with worse short-term outcome after bidirectional Glenn procedure. We sought to assess growth status at the time of the Fontan procedure and the effect of poor growth status on surgical outcomes.
This retrospective case series examined children who underwent Fontan at our institution between January 2003 and December 2008. Weight and height were obtained at the time of admission for Fontan. Data from preoperative echocardiogram and cardiac catheterization were abstracted to document cardiac function and hemodynamic measurements. Outcome variables included ventilator time, chest tube duration, postoperative infections (bacteremia, mediastinitis, urinary tract infection, gastroenteritis, or culture-positive pneumonia), and length of hospital stay.
Fifty-five patients were included for analysis. The median age at Fontan was 46 months (range, 18 to 72); median WAZ was -1.0 (-3.8 to +2.0), and height for age z-score was -1.1 (-3.7 to +1.5). The WAZ was less than -2.0 in 19% of patients. Multivariable modeling revealed that patients with a WAZ less than -2.0 (p=0.006) had a greater incidence of serious postoperative infections. The only factor predicting longer length of hospital stay was presence of a serious postoperative infection (p<0.0001). Ventilator time was predicted only by length of cardiopulmonary bypass (p=0.01). No factors were associated with longer chest tube duration.
Growth failure in children with a single ventricle persists through presentation for Fontan. A WAZ less than -2.0 at Fontan is associated with a higher rate of serious postoperative infections, which are associated with longer length of hospital stay.
The Annals of thoracic surgery 03/2011; 91(5):1460-6. · 3.74 Impact Factor
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ABSTRACT: Adequate nutritional support is essential for normal infant growth and development. Infants with congenital cardiac disease are known to be at risk for growth failure. We sought to describe perioperative growth in infants undergoing surgical repair of two-ventricle congenital cardiac disease and assess for predictors of their pattern of growth.Materials and methodsFull-term infants who underwent surgical repair of two-ventricle congenital cardiac disease at a single institution were enrolled in a retrospective cohort study performed following a larger prospective study. Infants with facial, gastrointestinal, or neurologic anomalies, trisomy chromosomal abnormality, birth weight less than 2500 grams, or those transferred to another institution before discharge home were excluded. The primary outcome was change in weight-for-age z score from surgery to discharge. Our secondary outcome variable was post-operative hospital length of stay.
A total of 76 infants met the inclusion criteria. Medain age at surgery was 5 days with a range from 1 to 44. The median weight-for-age z score at surgery was -0.2 with a range from -2.9 to 2.8 and by discharge had dropped to -1.2 with a range from -3.4 to 1.8. The median change in weight-for-age z score from surgery to discharge was -1.0 with a range from -2.3 to 0.2. Delayed post-operative nutrition (p < 0.001) and reintubation following initial post-operative extubation (p = 0.001) were associated with decrease in weight-for-age z score.
Infants undergoing repair of two-ventricle congenital cardiac disease had poor growth in the post-operative period. This may be mitigated by early initiation of post-operative nutrition.
Cardiology in the Young 03/2011; 21(4):421-9. · 0.76 Impact Factor
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ABSTRACT: The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) is the first quality improvement collaborative in pediatric cardiology, and its registry captures information on interstage care and outcomes of infants after the Norwood procedure. The purpose of this study was to evaluate variation in interstage outpatient clinical care practices for infants discharged home after the Norwood procedure.
Data for the first 100 infants enrolled in the NPC-QIC registry were evaluated. The care domains assessed for variation included: (1) discharge communication with outpatient cardiologist and primary care physician (PCP); (2) nutrition plan at hospital discharge; and (3) planned use of home surveillance strategies.
One hundred infants were discharged home between July 2008 and February 2010, from 21 participating US pediatric cardiac programs. Median age at discharge was 29 (11-188) days. Interstage outpatient care was provided at the Norwood center for 62 infants, at other centers for 25, and at a combination of centers for 13. Complete discharge communication (defined as written communication of medication list, nutrition plan, and red flag checklist) was relayed to only 45 outpatient cardiologists and to 26 PCPs. Nutrition route at discharge was exclusively oral in 49, combined oral and nasogastric (NG)/nasojejunal (NJ) in 38, exclusively NG/NJ in six, combined oral and gastrostomy tube (GT) in six, and exclusively GT in one infant. Home surveillance strategies were utilized for 81 infants (oximetry and weight monitoring in 77, oximetry alone in four), with no home surveillance in 19 infants.
Considerable variation exists in interstage outpatient care after the Norwood procedure in the care domains of discharge communication, nutrition, and home surveillance. Standardizing care around evidence-based practices may improve the outcomes for these very high-risk children.
Congenital Heart Disease 03/2011; 6(2):98-107. · 0.90 Impact Factor
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Cardiac electrophysiology clinics 12/2010; 2(4):499-507.
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Heart rhythm: the official journal of the Heart Rhythm Society 10/2010; 7(10):1516-7. · 4.56 Impact Factor
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ABSTRACT: To assess growth from the time of neonatal discharge to the time of performance of the bidirectional Glenn (BDG) procedure in infants with a single ventricle and determine predictors of poor growth.
We performed a retrospective case series of infants who underwent the BDG procedure at our institution between January 2001 and December 2007 (n=102). Anthropometric and clinical data were recorded during neonatal hospitalization and before BDG. Outcome variables included weight-for-age z-score (WAZ) at the time of BDG and average daily weight gain between neonatal discharge and BDG.
Median age at the time of BDG was 5.1 months (range, 2.4-10 months), and median WAZ was -0.4 (range, -2.6 to 3.2) at neonatal admission and -1.3 (range, -3.9 to 0.6) at the time of BDG. Non-Caucasian infants (P=.03) and those with lower WAZ at neonatal discharge (P<.0001) had a lower WAZ at BDG. Being formula-fed at neonatal discharge (P=.04), and having higher mean pulmonary arterial pressure (P=.04) and systemic oxygen saturation (P=.006) were associated with lower average daily weight gain between neonatal discharge and BDG.
Infants with a single ventricle have poor weight gain between neonatal discharge and BDG. Non-Caucasian infants and those with evidence of increased pulmonary blood flow are at particular risk for growth failure.
The Journal of pediatrics 09/2010; 157(3):407-13, 413.e1. · 4.02 Impact Factor
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ABSTRACT: Pompe disease is a rare genetic disorder that affects glycogen and lysosome storage secondary to a deficiency in the enzyme that breaks down glycogen (acid alpha-glucosidase). With such deficiency, glycogen buildup occurs within lysosomes and cells, causing dysfunction of several organ systems (typically skeletal and respiratory muscles). Within this disease, the spectrum of severity is attributed to the differing amounts of enzyme deficiency. The most severe and lethal of the spectrum is infantile-onset Pompe disease. In this population, there is less than 1% active enzyme activity with subsequent effect on the function of cardiac, respiratory, and skeletal muscle and hepatic and central nervous system activity. We report the case of a 5-month-old infant who presented with respiratory symptoms of bronchiolitis in the winter season. Physical examination, however, revealed findings suggestive of an underlying neuromuscular disorder and after thorough evaluation led to the diagnosis of infantile-onset Pompe disease. This case emphasizes the need to maintain clinical vigilance when treating common pediatric illnesses. The recognition of Pompe disease in this infant resulted in the initiation of contemporary treatment strategies delaying disease-related morbidity and mortality.
Pediatric emergency care 04/2010; 26(4):293-5. · 0.92 Impact Factor
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ABSTRACT: Poor growth has been described in infants with a single ventricle; however, little is known regarding its effect on surgical outcomes. We sought to assess the effect of nutritional status at the time of the bidirectional Glenn procedure on short-term outcomes.
We performed a retrospective case series of children who underwent the bidirectional Glenn procedure at our institution between January 2001 and December 2007. Anthropometric measurements were recorded at the time of neonatal admission and the bidirectional Glenn procedure. Data from preoperative echocardiograms and cardiac catheterization were recorded. The primary outcome variable was length of hospital stay.
Data on 100 infants were included for analysis. Age at the time of the bidirectional Glenn procedure was 5.1 months (range, 2.4-10 months). The median weight-for-age z score at birth was -0.4 (range, -2.6 to 3.2), and by the time of the bidirectional Glenn procedure, it had decreased to -1.3 (range, -3.9 to 0.6). In multivariable modeling longer postoperative hospital stays were predicted by lower weight-for-age z score (P = .02), younger age (P < .001), being fed through a gastrostomy tube (P = .01), and undergoing concomitant aortic arch reconstruction (P < .001) at the time of the bidirectional Glenn procedure.
There is suboptimal weight gain between neonatal discharge and the bidirectional Glenn procedure. A lower weight-for-age z score and younger age at the time of the bidirectional Glenn procedure affects length of hospital stay independent of hemodynamic or echocardiographic variables.
The Journal of thoracic and cardiovascular surgery 09/2009; 138(2):397-404.e1. · 3.41 Impact Factor
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ABSTRACT: Allografts used in the repair of congenital heart defects in children induce a persistent broad HLA antibody response. We have previously shown that a 3-month course of mycophenolic mofetil (MMF) significantly reduces the HLA class I antibody response to valved allograft implantation in children. The purpose of this study was to determine if this reduction in HLA antibody persists after discontinuation of MMF. We conducted follow-up (mean 2 +/- 0.5 years) of seven patients who had received allograft placement for repair of congenital heart defects. These patients received 3 months of immunosuppression with MMF following allograft implantation. When compared to historical controls, patients who received MMF following surgery showed a significantly decreased HLA class I antibody response at 2 years postimplantation. This study demonstrates the ability to persistently alter the HLA class I antibody response using 3 months of MMF following allograft implantation in children.
Transplantation 09/2005; 80(3):414-6. · 4.00 Impact Factor
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ABSTRACT: Valved allografts induce a brisk, broadly reactive human leukocyte antigen (HLA) antibody response in children after implantation. Mycophenolic mofetil (MMF) is a powerful immunosuppressant that inhibits the proliferation of both T cells and B cells and has been reported to possibly reduce HLA panel reactive antibody (PRA) in sensitized transplant recipients.
The purpose of this study was to determine whether MMF can blunt the HLA antibody response to valved allografts in children. Eight patients completed (of 28 approached) a pilot study to determine the effects of 3 months of twice daily MMF (600 mg/m(2)/dose) on the HLA antibody response measured before surgery, at 1 month, and at 3 months after implantation. Patients were 7.5 +/- 4 yrs old (mean +/- standard deviation [SD]), with 5 patients undergoing repair of tetralogy of Fallot, 2 Ross procedures, and 1 aortic valve replacement.
In contrast to historical controls with a virtual 100% HLA class I PRA response to valved allograft implantation, MMF markedly decreased the HLA class I antibody response at 1 and 3 months postimplantation. In 6 cases where the HLA type of the donor was defined, PRA specificity correlated with incompatible antigens on the allograft. One patient withdrew after 2 weeks due to a sinus infection that was successfully treated with oral antibiotics, and 3 patients had a transient adverse effect of postoperative vomiting.
This study demonstrates the ability to pharmacologically abrogate the HLA class I antibody response to valved allograft implantation in children using MMF.
The Annals of Thoracic Surgery 06/2004; 77(5):1734-9; discussion 1739. · 3.74 Impact Factor
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ABSTRACT: Recent advances in laparoscopic surgery as well as increasing experience with these techniques have led to the selection of laparoscopic surgery for many urological procedures. A lesser number of pediatric laparoscopic surgical studies have been reported. Few pediatric comparative laparoscopic versus open surgical procedure studies have been published. We compared 2 groups of similar pediatric patients who underwent partial nephrectomy via the laparoscopic or open technique.
A total of 22 consecutive partial nephrectomies were performed in pediatric patients 3 months to 15 years old. Of these procedures 11 chosen according to surgeon preference were performed laparoscopically and 11 were done by the open technique. Clinical data were obtained by chart review and compared retrospectively in the 2 groups. Demographic data, operative time and blood loss, the perioperative complication rate, hospital stay and costs, postoperative analgesic use and followup findings were compared.
Mean operative time in the laparoscopic and open groups was 200.4 and 113.5 minutes, respectively (p <0.0005). Blood loss was less than 50 cc in all patients. In the laparoscopic and open groups mean hospital stay was 25.5 and 32.6 hours (p = 0.068), and mean cost was $6,125 and $4,244 (p = 0.016), respectively. Patients in the laparoscopic group required fewer doses of analgesics than those who underwent open surgery (mean 10.9 versus 21, p = 0.041).
Our findings show that increased operative time and costs are disadvantages of pediatric laparoscopic nephrectomy compared with open techniques. Conversely decreased hospital stay, lower analgesic requirements and cosmesis support the use of laparoscopy for pediatric partial nephrectomy. These differences must be considered when deciding which technique is best for overall patient care.
The Journal of Urology 02/2003; 169(2):638-40. · 3.75 Impact Factor
