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Outcomes of gastrostomy placement with and without concomitant tracheostomy among ventilator dependent children. J Pediatr Surg 2021 Jul;56(7):1222-1226

Date

04/18/2021

Pubmed ID

33863556

DOI

10.1016/j.jpedsurg.2021.03.028

Scopus ID

2-s2.0-85104490488

Abstract

INTRODUCTION: Simultaneous gastrostomy tube (GT) and tracheostomy placement in young children offers potential benefit in limiting anesthetic exposure, but it is unknown whether combining these procedures introduces additional morbidity. This study compared outcomes after combined GT and tracheostomy placement versus GT placement alone among similar ventilator-dependent patients.

METHODS: Ventilator-dependent children <2-years-old who underwent GT placement alone (MV-GT), simultaneous GT and tracheostomy placement (GT+T), and GT placement alone with a pre-existing tracheostomy (T-GT) were identified using 2012-2018 NSQIP-Pediatric Participant User Files. Multiple logistic regression models were used to compare outcomes while adjusting for other group differences.

RESULTS: Among 1100 children, 351 underwent MV-GT, 494 GT+T, and 255 T-GT. Major complications occurred in 23.6%, 17.0%, and 14.5% of the respective groups (p = 0.01). Major complications with GT+T were similar to T-GT (adjusted odds ratio [aOR]=1.19, 95%CI:0.78-1.83, p = 0.4) and lower than MV-GT (aOR=0.67, 95%CI:0.47-0.95, p = 0.02). Severe complications including mortality, cardiac arrest, and stroke were similar between the three groups (p = 0.8).

CONCLUSIONS: Children <2-years-old undergoing GT+T did not experience higher post-operative complications compared to children undergoing T-GT or MV-GT. Utilizing GT+T to limit anesthetic exposure may be reasonable within this high-risk population.

TYPE OF STUDY: Treatment Study LEVEL OF EVIDENCE: Level III.

Author List

Bence CM, Salazar JH, Flynn-O'Brien KT, Mokdad AA, Gourlay DM, Van Arendonk KJ

Authors

Katherine T. Flynn-O'Brien MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin
David M. Gourlay MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Jose Salazar Osuna MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Kyle Van Arendonk MD, PhD Assistant Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Child
Child, Preschool
Fundoplication
Gastrostomy
Humans
Retrospective Studies
Tracheostomy
Ventilators, Mechanical