Should All Pyloromyotomies for Infantile Hypertrophic Pyloric Stenosis be Performed by Pediatric Surgeons?

Abstract Purpose Pyloromyotomies for infantile hypertrophic pyloric stenosis in academic centers are generally performed by pediatric surgeons (PS), while in non-specialized centers these are performed by general surgeons (GS). This cross-sectional study aims to address the paucity of data comparing the safety between PS and GS when performing a pyloromyotomy within NSQIP-P participating institutions. Methods Data from 2012–2020 was obtained from the ACS-National Surgical Quality Improvement Program Pediatric (NSQIP-P) database. All patients who underwent pyloromyotomy by GS or PS were included. Patients who underwent other concurrent procedures were excluded. Demographics and postoperative outcomes were compared. Bivariate analyses and multivariable logistic regression were performed with a P-value < 0.05 being considered statistically significant. Results A total of 18,453 pyloromyotomies were identified. Of these, 731 (4%) of cases were performed by GS and 17,722 (96%) by PS. The analysis indicated that several patient characteristics (weight, race, ASA class, comorbidities) and intra- and post-operative characteristics (operative length and hospital length of stay) were significantly different between groups. After adjusting for known risk factors, post-operative complications, re-admission rate, mortality and rate of re-operation were statistically similar between GS and PS. General surgeons were more likely to perform the operation via an open approach compared to pediatric surgeons (Adjusted OR 1.24 for Open vs Laparoscopic, 95% CI 1.04–1.49). No significant difference was found in conversion rates (Adjusted OR 1.45 for Conversion to Open vs Laparoscopic, 95% CI 0.68–3.08). Conclusion Our findings suggest no difference in outcomes within NSQIP-P participating institutions, which are primarily pediatric-focused. These results may not generalize to non-participating or community hospitals. Further validation in broader settings, including comparison with NSQIP Adult data, is needed. Level of Evidence III