Variability in the Method of Gastrostomy Placement in Children

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Health Services Research

Background:

• Gastrostomy tube placement is a common pediatric procedure.
• The optimal method for gastrostomy placement in children is not well-defined.
• Variability in surgical techniques can impact patient outcomes.

Purpose of the Study:

• To evaluate the variability in gastrostomy tube placement techniques in children across the United States.
• To identify factors associated with the choice between percutaneous endoscopic gastrostomy (PEG) and surgical gastrostomy (SG).

Main Methods:

• Analysis of the Kids' Inpatient Database (1997-2012) for pediatric gastrostomy placements.
• Inclusion of percutaneous endoscopic gastrostomy (PEG) and surgical gastrostomy (SG) (open or laparoscopic).
• Multivariable mixed-effects logistic regression to assess method variability and influencing factors.

Main Results:

• A total of 67,811 gastrostomy placements were analyzed.
• Percutaneous endoscopic gastrostomy (PEG) was used in 36.6% of cases.
• PEG use was lower in infants, urban hospitals, and children's hospitals, but higher with private insurance.
• Significant center-level variability in PEG use was observed, ranging from 0% to 100%.

Conclusions:

• There is substantial variability in gastrostomy placement methods across different centers in the US.
• Practice patterns for PEG placement differ significantly based on patient age, hospital type, and insurance.
• Further research is needed to determine the safest gastrostomy placement technique, particularly for infants.