C. T. Huerta1, W. A. Ramsey1, R. A. Saberi1, G. P. Gilna1, C. F. O’Neil1, E. A. Perez1, J. E. Sola1, C. M. Thorson1 1University Of Miami, Surgery, Miami, FL, USA
Introduction: Gastrostomy tube (GT) placement for enteral access is one of the most frequently performed procedures by pediatric surgeons for infants with numerous congenital conditions. There are discrepancies in the current literature regarding outcomes of infants with congenital cardiac anomalies (CCAs) undergoing GT placement. This study sought to characterize differences in procedural characteristics for GT placement in infants with CCAs and their effects on postoperative and readmission complications.
Methods: The Nationwide Readmission Database was queried from 2010 to 2014 for newborns who underwent gastrostomy tube (GT) placement during their index hospitalization. Patients were stratified into those with or without CCAs other than an isolated patent ductus arteriosus, atrial or ventricular septal defect, and compared using standard statistical tests. Results were weighted for national estimates.
Results: There were 5,997 patients identified who underwent GT placement. Patients with CCAs more frequently underwent open GT (59% vs. 55%) and less frequently underwent laparoscopic (17% vs. 19%) or percutaneous (24% vs. 26%) GT placement (p=0.043). Concomitant Ladd’s procedure for intestinal malrotation was more often performed in those with CCAs (10% vs. 4%, p<0.001). Overall index admission GT complications were similar between groups, including infection and overall GT complication (Table 1). Postoperative gastrointestinal disorders were more common in those without CCAs (Table 1). Evaluating only those undergoing laparoscopic GT, there were similar rates of GT complications (7% vs. 11%, p=0.073) and less readmission complications (0% vs. 5%, p<0.001) in those with CCAs compared to those without CCAs.
Patients with CCAs had higher overall readmission rates (39% vs 31%) and higher 30-day ($18,581 vs. $11,542) and overall median readmission costs ($35,787 vs. $20,073; all p<0.001). GT complications on readmission (5% vs. 3%), including GT infection (2% vs. 0.3%), were more common in those with CCAs compared to those without (both p<0.001).
Conclusion: During the newborn period, outcomes of gastrostomy tube placement are largely similar between patients with and without congenital cardiac anomalies. However, those with cardiac anomalies may experience more long-term complications based on readmission data. This knowledge may be used to develop interventions to improve healthcare delivery for this vulnerable patient population after GT placement.
