Population-based Study of Hypertrophic Pyloric Stenosis in Canada: Investigating the National Changes in Surgical Practice and Outcomes From 2004 to 2021

Background: Hypertrophic pyloric stenosis (HPS) is an acquired condition that causes gastric outlet obstruction in infants and requires operative treatment. We sought to explore the epidemiology, operative management and outcomes of HPS in Canada.

Methods: Canadian Institute for Health Information (CIHI) data for ICD-10 code for HPS and Canadian Classification of Health Interventions (CCI) code for pyloromyotomy in Canada (excluding Quebec) from 2004 to 2021 were obtained with REB approval. Data from 2004 to 2009, 2010-2015 and 2016-2021 were compared using Pearson's chi-square tests. Continuous variables were analyzed with one-way ANOVA tests. Significance was noted for p < 0.05.

Results: 6809 infants less than 12 months of age underwent pyloromyotomy for HPS from 2004 to 2021. The number of pyloromyotomies decreased when normalized to the national birth estimates over the study periods. 12.7 % of pyloromyotomies were performed laparoscopically from 2004 to 2009, and this increased to 47.4 % during 2016-2021. Pediatric surgeons performed 61 % of pyloromyotomies in 2004-2009 and this increased to 98 % of pyloromyotomies during the 2016 to 2021 period. There were no differences in the total length of stay (LOS) outcomes in the overall cohort, however, there was a statistically significant increase in the preoperative LOS outcomes in Ontario and the Prairies throughout the study periods.

Conclusions: Despite a relatively stable number of births over a 17-year period in Canada, the number of pyloromyotomies has decreased. In Canada, pyloromyotomies are increasingly performed laparoscopically and almost exclusively by pediatric surgeons, which reflects the regionalization of pediatric surgical care.

Type Of Study: Retrospective study.

Level Of Evidence: Level III.