The Association of Social Determinants of Health With Short Term Pediatric Gastrostomy Tube Outcomes

Matthew L Margol; Goeto Dantes; Valerie L Dutreuil; Afrin Jahan; Matthew T Santore; Allison F Linden

doi:10.1016/j.jss.2023.12.048

The Association of Social Determinants of Health With Short Term Pediatric Gastrostomy Tube Outcomes

J Surg Res. 2024 Apr:296:352-359. doi: 10.1016/j.jss.2023.12.048. Epub 2024 Feb 2.

Authors

Matthew L Margol¹, Goeto Dantes², Valerie L Dutreuil³, Afrin Jahan³, Matthew T Santore⁴, Allison F Linden⁴

Affiliations

¹ Emory University School of Medicine, Atlanta, Georgia; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: mlmargol@gmail.com.
² Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
³ Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
⁴ Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.

PMID: 38306941
DOI: 10.1016/j.jss.2023.12.048

Abstract

Introduction: Social determinants of health (SDH) have been found to be important contributors to postoperative outcomes, especially those related to procedures that require significant postoperative resources. The association between short-term gastrostomy tube (GT) outcomes and SDH in the pediatric population is unknown.

Methods: A retrospective review was performed of all patients less than 18 y old who received a GT between January 2018 and December 2020 at a single institution. Data including demographics, area deprivation index (ADI), and perioperative information were collected. Patient characteristics were compared in those that did and did not have an unexpected emergency department (ED) visit within 6 wk of discharge from GT placement. Statistical analysis was performed using Wilcoxon sum-rank, Chi-squared test, and Fisher's exact test where applicable, and univariable and multivariable logistic regression.

Results: Of the 541 children who underwent GT placement, 112 (20.7%) returned to the ED within 6 wk postdischarge. In univariable analysis, Black children had 1.64 the odds of an unexpected ED visit compared to White children (95% confidence interval [CI] 1.04-2.60, P = 0.03). When controlling for ethnicity, primary language, insurance, ADI and comorbidities, Black children had 1.80 the odds of an unexpected ED visit compared to White children (95% CI 1.10-2.97, P = 0.02). Final model fit which added a race by ADI interaction term revealed Black children had 2.52 the odds of an unexpected ED visit compared to White children in the low (1-6) ADI group (95% CI 1.41-4.60, P = 0.002). Within advantaged neighborhoods (ADI 1-6), the probability of unplanned ED visits for White children was 17.3% (95%CI 8.9% - 31.1%), which was significantly lower than that for Black children (34.6%, 95% CI 18.8% - 54.7%; P value = 0.006).

Conclusions: Race and neighborhood disadvantage can be associated with unexpected ED visits within 6 wk of discharge from GT placement in the pediatric population. For procedures that require significant postdischarge resources it is important to study the effect of SDH on return to the healthcare system as they can be an important driver of disparities in outcomes.

Keywords: Pediatric gastrostomy tube; Social determinants of health.

MeSH terms

Aftercare*
Child
Emergency Service, Hospital
Gastrostomy* / adverse effects
Humans
Patient Discharge
Retrospective Studies
Social Determinants of Health