Infant gastrostomy outcomes: The cost of complications

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Devices

Background:

• Percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) are common procedures for enteral feeding in infants.
• Comparative outcomes and cost-effectiveness of PEG versus LG in infants are not well-established.
• Infants represent a unique high-risk population for gastrostomy procedures.

Purpose of the Study:

• To compare the outcomes and procedural costs of enhanced PEG versus LG in infants.
• To identify significant complications associated with each gastrostomy method in this population.
• To evaluate the economic impact of complications for both PEG and LG.

Main Methods:

• Retrospective comparative study of 183 infants under one year of age undergoing gastrostomy (January 2011 - June 2015).
• Data collected included demographics, American Society of Anesthesiologists (ASA) class, cardiopulmonary disease, and 3-month complications.
• Charges and costs were analyzed using facility and professional administrative data.

Main Results:

• Seventy-eight PEG and 105 LG procedures were analyzed.
• LG infants were younger with higher ASA class and more frequent cardiopulmonary disease.
• PEG was associated with a higher incidence of gastrocolic fistula (3.8% vs 0%, p=0.04) and higher complication-related charges ($86,896).
• LG had a higher incidence of early tube dislodgement (7.6% vs 0%, p=0.01).
• Overall, PEG procedures incurred higher average charges and variable costs per case.

Conclusions:

• Despite a healthier cohort, infants undergoing enhanced PEG experienced more morbid and costly complications.
• Laparoscopic gastrostomy (LG) may represent a less burdensome and more cost-effective approach for gastrostomy in infants.
• Further research into optimizing gastrostomy techniques for infants is warranted.