Pyloric Stenosis: National Trends in the Incidence Rate and Resource Use in the United States From 2012 to 2016

Abstract

Infantile hypertrophic pyloric stenosis (IHPS) is the most common reason for abdominal surgery in infants; however, national-level data on incidence rate and resource use are lacking. We aimed to examine the national trends in hospitalizations for IHPS and resource use in its management in the United States from 2012 to 2016. METHODS:We performed a retrospective serial cross-sectional study using data from the National Inpatient Sample, the largest health care database in the United States. We included infants aged #1 year assigned an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for IHPS who underwent pyloromyotomy or pyloroplasty. We examined the temporal trends in the incidence rate (cases per 1000 live births) according to sex, insurance status, geographic region, and race. We examined resource use using length of stay (LOS) and hospital costs. Linear regression was used for trend analysis. RESULTS:Between 2012 and 2016, there were 32 450 cases of IHPS and 20 808 149 live births (incidence rate of 1.56 per 1000). Characteristics of the study population were 82.7% male, 53% white, and 63.3% on Medicaid, and a majority were born in large (64%), urban teaching hospitals (90%). The incidence of IHPS varied with race, sex, socioeconomic status, and geographic region. In multivariable regression analysis, the incidence rate of IHPS decreased from 1.76 to 1.57 per 1000 (adjusted odds ratio 0.93; 95% confidence interval 0.92-0.93). The median cost of care was $6078.30, whereas the median LOS was 2 days, and these remained stable during the period. CONCLUSIONS:The incidence rate of IHPS decreased significantly between 2012 and 2016, whereas LOS and hospital costs remained stable. The reasons for the decline in the IHPS incidence rate may be multifactorial.

The incidence of infantile hypertrophic pyloric stenosis nearly halved from 2005 to 2017: analysis of German administrative data

“…A similar development has been described for other surgical diseases such as inguinal hernia as well [22][23][24]. The underlying reasons remain unclear throughout the reports, irrespective of the disease [8,9,11,22,23].…”

“…Studies from the twentieth century described an increasing incidence of hypertrophic pyloric stenosis [3,4], whereas newer reports around the millennium documented a reversal of this trend [5][6][7][8][9][10][11]. A similar development has been described for other surgical diseases such as inguinal hernia as well [22][23][24].…”

“…Reports in the 1990s described an increasing incidence of infantile hypertrophic pyloric stenosis in the preceding decades [3,4]. Contrary to this finding, more recent studies found a decreasing incidence of infantile hypertrophic pyloric stenosis not just in Europe [5][6][7], but also in North America [8,9], Asia [10], and Oceania [11].…”

“…However, this finding seems to be influenced by seasonal [12], regional [7,13], ethnicity, and sex-specific effects [8]. It is, therefore, crucial to analyse population-based data including these aspects.…”

Prolonged neuromuscular block after rocuronium administration in laparoscopic pyloromyotomy patients: A retrospective bayesian regression analysis

“…Pyloromyotomy is the most common abdominal surgical procedure performed in infants with an incidence rate of 1.56 per 1000 live births 1 . These patients present with gastric outlet obstruction causing projectile vomiting that leads to dehydration and metabolic alkalosis.…”