A. J. Reiter1,2, F. Longi3, B. L. Thomae3, C. Jacobs3, G. A. Sullivan1,2, T. B. Lautz1, M. V. Raval1,2 1Feinberg School Of Medicine – Northwestern University, Division Of Pediatric Surgery, Chicago, IL, USA 2Feinberg School Of Medicine – Northwestern University, Surgical Outcomes Quality Improvement Center, Chicago, IL, USA 3Feinberg School Of Medicine – Northwestern University, Department Of Surgery, Chicago, IL, USA
Introduction: Complications after gastrostomy tube placement are common. A variety of surgical approaches have been promulgated to mitigate complications and, as a result, tremendous practice variation exists. The objective of this study was to determine if operative approach is associated with 30-day complication rates.
Methods: This single-center retrospective cohort study identified pediatric patients who underwent gastrostomy tube placement from June 2019 to April 2022. Gastrostomy approaches included: modified open (incision at gastrostomy site), laparoscopic, laparoscopic-assisted (incision at gastrostomy site), and percutaneous endoscopic gastrostomy (PEG). Multivariable logistic regression models were performed to evaluate the association of 30-day complications and operative approach after controlling for prematurity and weight.
Results: Among 521 gastrostomy patients, the median age was 10 months (interquartile range: 4-33 months) and 181 (34.9%) had a history of prematurity. Weight categories included 217 (41.6%) underweight (<5%tile), 272 (52.2%) normal weight, and 32 (6.1%) overweight (≥85%tile). Patients underwent modified open (n=33, 6.3%), laparoscopic (n=386, 74.1%), laparoscopic-assisted (n=73, 14.0%), and PEG (n=27, 5.2%). Complications included reoperation (n=17, 3.3%), readmission (n=12, 2.3%), wound infection (n=30, 5.8%), wound breakdown (n=21, 4.0%), tube dislodgement (n=23, 4.4%), granulation tissue (n=107, 20.5%), and leakage (n=33, 6.3%). Following adjustment, laparoscopic-assisted gastrostomy was associated with higher odds of any complication. Modified open and laparoscopic-assisted were associated with higher odds of wound breakdown. Modified open and laparoscopic-assisted were associated with higher odds of leakage (Table). Operative approach was not associated with reoperation, readmission, wound infection, or tube dislodgement.
Conclusion: Techniques for gastrostomy placement which include an incision around the tube were associated with higher rates of complications. To improve complication profiles for patients, surgeons should consider laparoscopic or percutaneous endoscopic gastrostomies.
