Morbidity and Mortality After Gastrostomy Tube Placement Among Infants With Congenital Heart Disease

We sought to characterize the morbidity and mortality associated with gastrostomy tube (GT) placement in infants with cardiac risk factors.

A cross-sectional study using the National Surgical Quality Improvement Program-Pediatric from 2012 to 2021 was completed. Infants (aged ≤365 d) undergoing a GT placement were stratified by preoperative cardiac risk factors and analyzed for the composite occurrence of death, stroke, and/or cardiac arrest.

There were 20,823 infants analyzed. The composite outcome occurred in 56 (0.7%) patients with no cardiac risk factors, 62 (1.2%) patients with minor risk factors, 130 (2.0%) patients with major risk factors, and 55 (4.2%) patients with severe risk factors (P < 0. 001). The composite outcome was significantly associated with age <3 mo (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.05-2.05), ventilator dependence (OR 2.23, 95% CI 1.52-3.28), and oxygen support (OR 2.22, 95% CI 1.59-3.11). Of the 1084 patients with diagnoses consistent with single ventricle physiology, there were 26 deaths (2.7%); 21 (81%) were aged <3 mo at the time of GT placement.

Infants with cardiac disease undergoing GT placement have significant morbidity and mortality. Factors including age <3 mo, ventilator dependence, and oxygen support were strongly associated with an increased risk of death, stroke, or cardiac arrest. The high risk of the procedure should be considered when evaluating the feeding plan for infants with congenital heart disease.