A retrospective study (AB Goldin et al. J Pediatric 2016; 174: 139-45) provides a better idea about the likelihood of complications by looking for ED visits and admissions within 30 days of placement.
This study involved 38 Children’s Hospitals and 15,642 patients the Pediatric Health Information System (PHIS) database. Key findings:
- 8.6% had an ED visit within 30 days
- 3.9% had an admission within 30 days
- Common reasons for return visits: infection (27%), mechanical complication (22%) and replacement (19%).
The authors note that risk factors for ED visits and admission were mainly non modifiable like race/ethnicity and medical complexity. They also note that problems in the early postoperative period are grossly underestimated due to many issues being addressed in the outpatient setting.
This study indicates that there is a tremendous opportunity for improvement. There is great variation in hospital practices with regard to the type and method of placing gastrostomy tube. In addition, there is a high variability in the determination of the need for fundoplication which is often undertaken at the time of gastrostomy tube placement.
My take: Understanding these risks is important to give families accurate information prior to placement of gastrostomy tubes. In addition, these high rates of complications indicate the need for head-to-head prospective trials comparing types of gastrostomy tube placement and education efforts.
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