Partial Duodenal Obstructions: A National Surgical Quality Improvement Program Pediatric Analysis of Clinical Factors.

INTRODUCTION

Duodenal atresia is one of the most common causes of intestinal obstruction, typically presenting in the first few days of life. Partial duodenal obstructions (PDO) can allow for the passage of liquids and may not be diagnosed in early infancy until feeding intolerance becomes more apparent. We aimed to identify characteristics of patients who may have PDO and describe their outcomes.

METHODS

Utilizing the National Surgical Quality Improvement Program-Pediatric database, patient characteristics and surgical outcomes were compared between patients who underwent operative repair for duodenal obstructions before 180 d (full duodenal obstruction) and after 180 d (PDO).

RESULTS

Of 2213 patients who underwent procedures for duodenal obstructions between 2012 and 2020, 138 were performed after 180 d (PDO). These patients were more likely to be male (66.7 versus 49.7%, P = 0.0001), have a structural pulmonary/airway abnormality (10.9 versus 2%, P < 0.0001), developmental delay (33.3 versus 12.2%, P < 0.0001), and undergo elective surgery (70.3 versus 43.7%, P < 0.0001). Patients who underwent surgery before 180 d (full duodenal obstruction) were more likely to have major cardiac risk factors (32.2 versus 12.3%, P < 0.0001) and birthweight <1500g (7.3 versus 0%, P = 0.0010). Readmission (11.7 versus 3.1%), reoperation (13.3 versus 4.1%), organ space infection (3.9 versus 0.3%), and sepsis (3.9 versus 1.6%) were more likely in patients undergoing procedures after 180 d (PDO) (P < 0.05).

CONCLUSIONS

PDO appears more likely in patients without the characteristic cardiac risk factor comorbidities. Recognizing these factors will be important for timely surgical intervention to minimize postoperative complications.