Increased Hospital System Utilization After Gastrostomy in Children Is Related to Neighborhood

Disparities relating to social and economic advantage exist in pediatric surgery. To better identify specific areas of improvement, we evaluated long term gastrostomy (G-) tube outcomes at our children's hospital to assess the relationship to a child's neighborhood.

Patients with G-tubes placed between January 2011 and May 2018 were included. We gathered demographic and outcomes data retrospectively and assigned national Area Deprivation Index (ADI) and Child Opportunity Index (COI) scores to each patient. Univariate comparisons were made between groups with higher and lower index scores, as defined by the median score for our population. Kaplan-Meier survival analysis was used to evaluate time to first tube dislodgment.

There were 183 and 185 children with accessible ADI and COI scores, respectively. The median follow-up time was 5.6-5.8 y. Children with less social advantage had significantly higher mean G-tube related emergency department (ED) visits per child, a higher proportion of very high ED utilizers (children with ≥5 ED visits), and a longer length-of-stay following G-tube placement, all of which were consistent across both ADI and COI scores. Survival curves analyzing G-tube dislodgement within 90 d demonstrate children identified as White with more advantage have the lowest risk of dislodgement. Children identified as Black or African American with any level of advantage had the highest risk of dislodgement.

Identifying specific outcomes related to patients' environmental advantage is critical for efficient allocation of resources to target disparities; once a baseline is established, these metrics can be considered for continued outcomes tracking to evaluate for effective improvement and disparity mitigation.