Infant gastrostomy outcomes: The cost of complications. J Pediatr Surg 2016 Dec;51(12):1976-1982
Date
09/30/2016Pubmed ID
27678507DOI
10.1016/j.jpedsurg.2016.09.025Scopus ID
2-s2.0-84995740106 (requires institutional sign-in at Scopus site) 32 CitationsAbstract
PURPOSE: Comparative outcomes of enhanced percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) have not been elucidated in infants. We describe the outcomes and procedural episodic expenditures of PEG versus LG in this high-risk population.
METHODS: One hundred eighty-three gastrostomies in children under 1year were reviewed from our institution spanning 1/2011-6/2015. Pertinent demographics and 3-month complications (mortality, gastrocolic fistula, reoperation, cellulitis, granulation, pneumonia, and tube dislodgement <6weeks) were collected. Facility and professional administrative data was used to conduct a charge and cost analysis of PEG and LG procedures as well as their statistically significant complications.
RESULTS: Seventy-eight PEG and 105 LG infants were compared. LG infants were significantly younger, had higher ASA class, and increased frequency of cardiopulmonary disease. Significant major complications included a 3.8% incidence of gastrocolic fistula among PEGs (3.8% vs 0%, p=0.04) and 7.6% early tube dislodgements among LG infants (0 vs. 7.6%, p=0.01), resulting in $86,896 of additional charges with PEG complication. Incorporating complication frequency, average charges and variable cost per case were $8964 and $253 greater using PEG.
CONCLUSIONS: Despite a healthier cohort, infants undergoing enhanced PEG have more morbid and costly complications. LG may be the less burdensome approach to gastrostomy in infants.
LEVEL OF EVIDENCE: Case-Control Study/Retrospective Comparative Study - Level III.
Author List
Landisch RM, Colwell RC, Densmore JCAuthor
John C. Densmore MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Case-Control StudiesFemale
Follow-Up Studies
Gastroscopy
Gastrostomy
Hospital Charges
Hospital Costs
Humans
Incidence
Infant
Infant, Newborn
Laparoscopy
Male
Postoperative Complications
Reoperation
Retrospective Studies
Wisconsin