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Predictors of multiple readmissions or death in the first year after Nissen fundoplication in children



Nissen fundoplication (NF) is commonly performed in children with gastro-esophageal reflux disease (GERD). Patients undergoing NF often have co-morbidities. Reported outcomes of NF vary considerably. This study investigated which factors might predict multiple readmissions or death in the first year following NF at our institution.


A retrospective chart review of 187 children who underwent NF at our institution between January 2004 and December 2015 was undertaken. Underlying medical conditions, age, weight, presence of malnutrition, length of hospital stay prior to surgery and type of surgery were recorded. Patients who had more than one admission in the first post-operative year were compared to those who had one or none, and patients who died within the first post-operative year were compared to those who did not.


Risk factors for multiple readmissions were underlying cardiac disease (p = 0.011), esophageal atresia (EA) (p = 0.011), and esophageal stricture (p = 0.0002). Risk factors for death included younger age (p = 0.028), need for gastrostomy tube (GT) (p = 0.01) and prolonged pre-operative hospital admission (p = 0.0003).


This study identified multiple factors associated with readmission and death in the first year after NF. These findings will help with the counseling patients and caregivers regarding expectations following NF.

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No funding was sought or received for this study.

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Corresponding author

Correspondence to Karen Milford.

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There are no conflicts of interest to declare.

Ethical approval

No procedures were performed on humans for the purposes of this review. Rather, we retrospectively reviewed outcomes in patients who had medically indicated procedures. Approval for this study was obtained from the Human Research Ethics Committee at the University of Cape Town Faculty of Health Sciences (reference number HREC 474/206) As such, this study was in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Milford, K., Numanoglu, A., Sultan, T.A. et al. Predictors of multiple readmissions or death in the first year after Nissen fundoplication in children. Pediatr Surg Int 35, 501–507 (2019).

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  • GERD
  • Nissen
  • Fundoplication
  • Readmission
  • Mortality