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Gastrostomy tube placement in congenital cardiac surgery: a multi-institutional database study
Brena S Haughey1, Peter Dean1, Michael C Spaeder2
1Department of Pediatrics (Cardiology), University of Virginia, Charlottesville, VA, USA.
Insights
Neonates undergoing congenital cardiac surgery have a higher incidence of gastrostomy tube placement compared to infants. Factors like age and anomalies influence this need, impacting hospital stay and cost.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Cardiology
Background:
- Congenital cardiac surgery patients often experience feeding difficulties.
- Factors influencing gastrostomy tube (GT) need are not well-defined.
- This study investigates GT incidence and outcomes in this population.
Purpose of the Study:
- To determine the incidence of GT placement in neonates and infants post-congenital cardiac surgery.
- To describe hospital outcomes and patient characteristics associated with GT placement.
- To identify risk factors for GT requirement.
Main Methods:
- Retrospective review of 11,793 congenital cardiac surgery admissions (Oct 2015-Dec 2020).
- Patients stratified into neonates (<1 month) and infants (1-12 months).
- Comparative analysis of outcomes between patients with and without GT placement.
Main Results:
- GT placement incidence was 23.1% in neonates vs. 6% in infants (p < 0.001).
- GT placement correlated with increased length of stay and cost.
- Higher likelihood of GT placement in patients with upper airway anomalies, congenital abnormalities, infections, and genetic abnormalities.
Conclusions:
- Age at hospitalization is a significant risk factor for GT requirement after congenital cardiac surgery.
- Additional factors, including comorbidities, should inform family counseling.
- Understanding these factors can improve patient management and family preparedness.
Introduction:
Neonates and infants who undergo congenital cardiac surgery frequently have difficulty with feeding. The factors that predispose these patients to require a gastrostomy tube have not been well defined. We aimed to report the incidence and describe hospital outcomes and characteristics in neonates and infants undergoing congenital cardiac surgery who required gastrostomy tube placement.
Materials And Method:
A retrospective review was performed on patients undergoing congenital cardiac surgery between October 2015 and December 2020. Patients were identified by International Classification of Diseases 10th Revision codes, utilising the performance improvement database Vizient® Clinical Data Base, and stratified by age at admission: neonates (<1 month) and infants (1-12 months). Outcomes were compared and comparative analysis performed between admissions with and without gastrostomy tube placement.
Results:
There were 11,793 admissions, 3519 (29.8%) neonates and 8274 (70.2%) infants. We found an increased incidence of gastrostomy tube placement in neonates as compared to infants following congenital cardiac surgery (23.1% versus 6%, p = <0.001). Outcomes in neonates and infants were similar with increased length of stay and cost in those requiring a gastrostomy tube. Gastrostomy tube placement was noted to be more likely in neonates and infants with upper airway anomalies, congenital abnormalities, hospital infections, and genetic abnormalities.
Discussion:
Age at hospitalisation for congenital cardiac surgery is a definable risk factor for gastrostomy tube requirement. Additional factors contribute to gastrostomy tube placement and should be used when counselling families regarding the potential requirement of a gastrostomy tube.
