Outcomes of gastrostomy placement with and without concomitant tracheostomy among ventilator dependent children

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Simultaneous gastrostomy tube (GT) and tracheostomy placement in young children may reduce anesthetic exposure.
• The comparative morbidity of combined GT and tracheostomy placement versus GT alone in ventilator-dependent children is not well-established.

Purpose of the Study:

• To compare post-operative outcomes between combined GT and tracheostomy placement versus GT placement alone in ventilator-dependent children.
• To evaluate the safety and efficacy of combined procedures in minimizing anesthetic exposure.

Main Methods:

• Retrospective cohort study using the 2012-2018 NSQIP-Pediatric database.
• Included ventilator-dependent children under 2 years old undergoing GT placement alone (MV-GT), simultaneous GT and tracheostomy placement (GT+T), or GT placement alone with a pre-existing tracheostomy (T-GT).
• Used logistic regression to compare outcomes, adjusting for group differences.

Main Results:

• Of 1100 children, 351 had MV-GT, 494 had GT+T, and 255 had T-GT.
• Major complications occurred in 23.6% (MV-GT), 17.0% (GT+T), and 14.5% (T-GT) (p=0.01).
• GT+T had similar major complications compared to T-GT (aOR=1.19) and fewer than MV-GT (aOR=0.67). Severe complications were similar across groups.

Conclusions:

• Combined GT and tracheostomy placement in children under 2 years old did not result in higher post-operative complications compared to other groups.
• This combined approach may be a reasonable strategy to limit anesthetic exposure in this high-risk pediatric population.