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Open Gastrostomy Tube Placement is Associated With Higher Complications in Infants: A National Surgical Quality
Nicholas Piening1, Hector Osei2, Armando Salim Munoz Abraham2
1Department of Pediatric Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri.
Insights
Open gastrostomy (OGT) in infants is linked to higher complication and mortality rates compared to laparoscopic gastrostomy (LGT). Even after adjustments for patient factors, OGT remains associated with increased complications, suggesting LGT may be a safer option.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Minimally Invasive Surgery
Background:
- Gastrostomy is a common procedure in infants for feeding access.
- Both open gastrostomy (OGT) and laparoscopic gastrostomy (LGT) are utilized in pediatric patients.
- Understanding comparative outcomes is crucial for surgical decision-making.
Purpose of the Study:
- To compare complication and mortality rates between open and laparoscopic gastrostomies in children aged one year or younger.
- To evaluate the safety and efficacy of different gastrostomy approaches in a vulnerable pediatric population.
Main Methods:
- Retrospective analysis of the American College of Surgeons' National Surgical Quality Improvement Program Pediatric database (2012-2017).
- Chi-square analysis was used to compare outcomes in infants (≤1 year) undergoing OGT versus LGT.
- Matched control analysis was performed to account for patient comorbidities.
Main Results:
- A total of 7940 infants were included; 20% had OGT and 80% had LGT.
- Infants undergoing OGT were younger, smaller, more likely to be inpatients, and had more congenital malformations.
- Complication (6% vs. 4%) and mortality (2.3% vs. 0.6%) rates were significantly higher in the OGT group.
- Matched control analysis confirmed higher complication rates for OGT.
Conclusions:
- Infants undergoing open gastrostomy (OGT) present with greater comorbidities and poorer outcomes compared to those receiving laparoscopic gastrostomy (LGT).
- Even after matched analysis, OGT is associated with significantly higher complication and mortality rates.
- Laparoscopic gastrostomy (LGT) appears to be a safer alternative for gastrostomy placement in infants.
Background:
The purpose of this study was to compare outcomes between open versus laparoscopic gastrostomies in children aged ≤1 y.
Methods:
The American College of Surgeons' National Surgical Quality Improvement Program Pediatric database was reviewed between 2012 and 2017. Chi-square analysis was performed on children aged ≤1 y to compare complication rates between open and laparoscopic procedures.
Results:
A total of 7940 patients were aged ≤1 y. Of which, 20% underwent open gastrostomy (OGT), and 80% received laparoscopic gastrostomy (LGT). There were no differences in sex or race. However, OGT patients were younger (119 d versus 134 d; P = 0.0001), smaller at birth (1.84 kg versus 1.85 kg; P = 0.03), and were smaller at operation (4.6 kg versus 5 kg; P = 0.0001). Also, patients were more likely to be inpatient at the time of surgery and had more congenital malformations. Complications (OGT 6% versus LGT 4%; P = 0.001) and mortality were significantly higher in the open group (OGT 2.3% versus LGT 0.6%; P = 0.001). However, matched control analysis demonstrated OGT patients have more complications.
Conclusions:
OGT patients are smaller and with more significant comorbidities in this data set. In fact, even after matched control analysis, these patients experience more complications.
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