Complication Rates and Variability in Gastrojejunostomy Tube Usage in Infants and Children

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Health Services Research

Background:

• Gastrojejunostomy tubes (GJT) are crucial for enteral access in children with feeding intolerance.
• Previous research suggested higher complication risks for infants undergoing GJT placement compared to older children.
• This study investigates GJT usage and associated postoperative complications in children using national databases.

Purpose of the Study:

• To characterize gastrojejunostomy tube (GJT) usage in pediatric patients.
• To identify risk factors for postoperative complications following GJT placement in children.
• To compare complication rates between infants and non-infants undergoing GJT placement.

Main Methods:

• Retrospective cohort study utilizing the Pediatric American College of Surgeons National Surgical Quality Improvement Program (Ped-NSQIP) and Pediatric Health Information System (PHIS) databases.
• Comparison of complication rates between infants (<1 year) and non-infants (≥1 year) within each database.
• Multivariable logistic regression analysis to identify predictors of postoperative complications.

Main Results:

• Infants did not show an increased rate of surgical complications compared to non-infants in either database (Ped-NSQIP: 26.9% vs. 29.0%; PHIS: 35.3% vs. 30.7%).
• Increased complication risk was observed in African American children (infants and non-infants) and for urgent/emergent procedures in both age groups.
• Significant institutional variation in GJT placement and complication rates was noted.

Conclusions:

• Overall complication rates for gastrojejunostomy tube (GJT) placement are substantial but similar between infants and non-infants.
• Postoperative complication risks are associated with race and procedure urgency, not solely with age.
• GJT placement should be considered when indicated for enteral access in children, irrespective of age.