13.11 Gastrostomy Tube Placement Before First Cardiac Surgery is Associated with Increased Complications

Posted on January 31, 2019

H. Osei2, A. S. Abraham2, A. Martino1, S. Kazmi1, K. Bates1, J. S. Kim1, J. Myint1, K. Chatoorgoon1,2, F. Colleen1,2, G. A. Villalona1,2, J. Greenspon1,2  1Saint Louis University,School Of Medicine,St. Louis, MO, USA 2SSM Cardinal Glennon Children’s Hospital,Pediatric Surgery,St. Louis, MO, USA

Introduction:

Gastrostomy tube placement in pediatric patients has gained wide acceptance for long-term enteral nutrition support. We aimed to determine whether type of congenital heart disease (CHD) affects outcomes of patients undergoing gastrostomies.

Methods:

A retrospective review of all gastrostomy tube placement at our institution from 2010 to 2017 was performed. Data collected included demographics, type of congenital heart disease (CHD), timing of cardiac surgery, outcomes and 90-day complications. We divided the patients into patients with non-cyanotic CHD (Group A) and patients with cyanotic CHD (Group B).  Chi-square test and independent t-test analysis were performed as appropriate to compare the two groups. Multivariable analysis with logistic regression was performed for concurrent evaluation of predictive factors for complications. Outcomes with two-sided p ≤ 0.05 were considered significant.

Results:

Eighty two patients met criteria, Group A consisted of 62 patients (75.6%)  and Group B had 20 patients (24.4%). Forty-one patients (50%) were male. Mean age for patients with CHD was 19.6 months (SD 47.3 months). There were no differences in demographics, procedure (laparoscopy or open), mean operative time or type of tube placed between the two groups. Group A patients had more complications (69% vs 40%, p=0.019), both in univariate and multivariable analysis (adjusted odds ratio, 4.30 [1.34 – 13.79], p=0.014). However, cyanotic CHD patients who had their gastrostomies placed prior to initial cardiac surgery had significantly higher complications when compared to those after initial cardiac surgery (53.3% vs 0%, p=0.035).

Conclusion:

For patients with cardiac disease undergoing gastrostomy, non-cyanotic congenital heart disease have higher complications. On the other hand, patients with cyanotic congenital heart disease that underwent gastrostomy before initial cardiac surgery had increased complications. Gastrostomy tube placement should likely be delayed until after first cardiac surgery is performed.