National trends and outcomes of pediatric gastrostomy tube placement Articles uri icon

authors

  • Fox, D.
  • Campagna, E.J.
  • Friedlander, J.
  • Partrick, D.A.
  • REES, DANIEL IRA
  • Kempe, A.

publication date

  • January 2014

start page

  • 582

end page

  • 588

issue

  • 5

volume

  • 59

International Standard Serial Number (ISSN)

  • 0277-2116

Electronic International Standard Serial Number (EISSN)

  • 1536-4801

abstract

  • Objectives: National outcomes data regarding surgical gastrostomy tube (G-tube) and percutaneous endoscopic gastrostomy (PEG) tube procedures are lacking. Our objectives were to describe trends in G-tube and PEG procedures, examine regional variation, and compare outcomes. Methods: This was a retrospective study using pediatric admissions during 1997, 2000, 2003, 2006, and 2009 from the Kids' Inpatient Database. Length of stay and cost were adjusted for demographics, complexity, setting, year, and infection or surgical complication. Results: G-tubes were placed during 64,412 admissions, increasing from 16.6 procedures/100,000 US children in 1997 to 18.5 in 2009. Surgical gastrostomy rates increased by 19% (0.17 procedures/100,000/year, P<0.002) and, among children <1 year, they increased by 32% (2.56 procedures/100,000/year, P <0.01). PEG rates did not increase (0.02 procedures/100,000/year, P=0.47) in the study years. The West had an 18% higher rate than the national average for surgical G-tubes and a 10% higher rate for PEGs. When the sole procedure during the admission was gastrostomy, the G-tube was associated with a 19% (confidence interval 9.7-57.5) longer length of stay, and a 25% higher cost (confidence interval 16.4-34.5) compared with PEG. Conclusions: Surgical gastrostomy insertion rates have increased whereas PEG rates have not, despite evidence of better severity-adjusted outcome measures for PEG tubes. Surgical gastrostomy insertion in children <1 year of age yielded the greatest increase, which may relate to a changing patient population; however, regional variation suggests that provider preference also plays a role. Our data underline the need for more robust collection and analysis of surgical outcomes to guide decision making. Copyright © 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

keywords

  • gastrostomy kids' inpatient database percutaneous endoscopic gastrostomy surgical outcomes adolescent article child child hospitalization female gastrostomy health care cost hospital admission human icd-9 length of stay major clinical study male medical decision making percutaneous endoscopic gastrostomy priority journal retrospective study stomach fundoplication stomach tube digestive tract intubation enteric feeding infant newborn postoperative complication preschool child procedures trends united states adolescent child child; preschool enteral nutrition female gastrostomy health care costs humans infant infant; newborn intubation; gastrointestinal length of stay male postoperative complications retrospective studies united states