Estimating Adverse Events After Gastrostomy Tube Placement

Anne M Stey; Brian D Kenney; Mark E Cohen; R Lawrence Moss; Bruce L Hall; Loren Berman; Kari Kraemer; Clifford Y Ko; Charles D Vinocur

doi:10.1016/j.acap.2015.05.004

Estimating Adverse Events After Gastrostomy Tube Placement

Acad Pediatr. 2016 Mar;16(2):129-35. doi: 10.1016/j.acap.2015.05.004. Epub 2015 Aug 22.

Authors

Anne M Stey¹, Brian D Kenney², Mark E Cohen³, R Lawrence Moss², Bruce L Hall⁴, Loren Berman⁵, Kari Kraemer³, Clifford Y Ko⁶, Charles D Vinocur⁵

Affiliations

¹ Icahn School of Medicine at Mount Sinai Medical Center, New York, NY; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif. Electronic address: as013j@gmail.com.
² Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
³ American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, Ill.
⁴ American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, Ill; Washington University School of Medicine in Saint Louis, Department of Surgery, Olin Business School, and Center for Health Policy, St Louis VA Medical Center; BJC Healthcare, Saint Louis, Mo.
⁵ Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, Del.
⁶ David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif; American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, Ill.

PMID: 26306663
DOI: 10.1016/j.acap.2015.05.004

Abstract

Objective: Gastrostomy feeding tube placement in children is associated with a high frequency of adverse events. This study sought to preoperatively estimate postoperative adverse events in children undergoing gastrostomy feeding tube placement.

Methods: This was an observational study of children who underwent gastrostomy with or without fundoplication at 1 of 50 participating hospitals, using 2011-2013 data from the American College of Surgeons' National Surgical Quality Improvement Program Pediatric. The outcome was the occurrence of any postoperative complications or mortality at 30 days after gastrostomy tube placement. The preoperative clinical characteristics significantly associated with occurrence of adverse events were included in a multivariate logistic model. The area under the receiver operating characteristic curve was computed to assess model performance and split-set validated.

Results: A total of 2817 children were identified as having undergone gastrostomy tube placement. The unadjusted rate of adverse events within 30 days after gastrostomy tube placement was 11%. Thirteen predictor variables were identified. Notable preoperative variables associated with a greater than 75% increase in adverse event rate were preoperative sepsis/septic shock (odds ratio [OR], 10.76, 95% confidence interval [CI], 3.84-30.17), central nervous system tumor (OR, 3.36; 95% CI, 1.42-7.95), the primary procedure as indicated by the current procedural terminology (CPT) linear risk variable (OR, 1.93; 95% CI, 1.50-2.49), severe cardiac risk factors (OR, 1.88; 95% CI, 1.17-3.03), and preoperative seizure history (OR, 1.90; 95% CI, 1.38-2.62). The area under the receiver operating characteristic curve was 0.71 with the derivation data set and 0.71 upon split-set validation.

Conclusions: Preoperatively estimating postoperative adverse events in children undergoing gastrostomy tube placement is feasible.

Keywords: ACS-NSQIP-Pediatric; children with special health care needs; gastrostomy enteral access; risk calculator.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Cardiovascular Diseases / epidemiology*
Central Nervous System Neoplasms / epidemiology*
Child
Child, Preschool
Female
Fundoplication*
Gastrostomy / adverse effects
Gastrostomy / instrumentation*
Humans
Infant
Infant, Newborn
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Postoperative Complications / epidemiology*
ROC Curve
Retrospective Studies
Risk Assessment
Risk Factors
Seizures / epidemiology*
Sepsis / epidemiology
Shock, Septic / epidemiology*