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Identifying Quality Improvement Targets After Pediatric Gastrostomy Tube Insertion: A NSQIP-Pediatric Pilot Study
Anoosha Moturu1, Melvin Coleman2, Catherine Mets2
1American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA; Stanford Healthcare, Stanford, CA, USA.
Insights
Pediatric gastrostomy tube (GT) placement shows significant variation in preoperative imaging and high rates of post-procedure complications like dislodgement and emergency visits. Standardizing care can improve outcomes for children needing GTs.
Area of Science:
- Pediatric Surgery
- Surgical Quality Improvement
- Healthcare Data Analytics
Background:
- Gastrostomy tube (GT) placement is a common pediatric surgical procedure.
- Lack of a national registry for GT care processes and morbidity hinders quality assessment.
- The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Ped) GT Pilot was established to collect relevant data.
Purpose of the Study:
- Analyze variability in perioperative practices for pediatric GT operations.
- Identify rates and types of post-operative morbidity associated with pediatric GT placement.
- Provide data to guide future quality improvement (QI) interventions and research.
Main Methods:
- Retrospective cohort analysis of the ACS NSQIP-Ped database (2023).
- Included pediatric patients (0-17 years) undergoing GT placement.
- Examined preoperative upper gastrointestinal (UGI) study utilization and postoperative outcomes (e.g., ED visits, GT dislodgement).
Main Results:
- GT placement constituted 5.3% of all pediatric operations in the NSQIP-Ped database.
- Participating pilot hospitals submitted 57% of GT cases, with 77% being first-time placements.
- Preoperative UGI study utilization varied widely (0-99%), with 45% overall use. Postoperative morbidity included 14% ED visits and 5.2% GT dislodgements.
Conclusions:
- Significant interhospital variability exists in preoperative UGI study use for pediatric GT placement.
- High rates of postoperative morbidity, including emergency department visits and GT dislodgements, were observed.
- Findings highlight the need for standardized clinical practices to reduce complications and improve pediatric GT care.
Background:
Gastrostomy tube (GT) placement is one of the most common procedures performed by pediatric surgeons; however, no current national clinical data registry exists to assess GT-specific care processes and morbidity. The American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIPPed) GT Pilot was created to provide participants with these data. This study aims to analyze these data to identify variability in perioperative practices and post-operative morbidity in pediatric GT operations and to provide targets for future quality improvement (QI) interventions.
Methods:
This retrospective cohort analysis of the ACS NSQIP-Ped database included pediatric surgical patients (0-17 years) who underwent GT placement between January 1, 2023 and December 31, 2023. The analysis focused on perioperative measures, such as preoperative upper gastrointestinal (UGI) study utilization, and postoperative morbidity outcomes, including emergency department (ED) visits related to GT placement and dislodgements.
Results:
GT placement represented 5.3 % (8047/151508) of operations submitted to the NSQIP-Ped from all 157 hospitals in 2023. The 71 pilot hospitals that voluntarily participated in this pilot study submitted 57 % (4612/8047) of GT cases, with 77 % (3563/4612) of these cases being first-time GT. UGI studies were obtained in 45 % (1600/3563) of GT cases, with substantial interhospital variability (0-99 %). Postoperative morbidity outcomes included ED visits within 0-30 days in 14 % of GT cases and GT dislodgement in 5.2 % of cases.
Conclusions:
Within pediatric GT placement, high variability exists in preoperative UGI use and high postoperative GT-related morbidity, including ED visits and dislodgements among pediatric facilities. The results of this analysis can inform prioritization of future GT QI interventions and research which aim to standardize clinical practice and reduce the incidence of these complications.
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