Faculty Collaboration Database

Infant gastrostomy outcomes: The cost of complications. J Pediatr Surg 2016 Dec;51(12):1976-1982

Date

09/30/2016

Pubmed ID

27678507

DOI

10.1016/j.jpedsurg.2016.09.025

Scopus ID

2-s2.0-84995740106 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

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 JC

Author

John C. Densmore MD Professor in the Surgery department at Medical College of Wisconsin

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

Case-Control Studies
Female
Follow-Up Studies
Gastroscopy
Gastrostomy
Hospital Charges
Hospital Costs
Humans
Incidence
Infant
Infant, Newborn
Laparoscopy
Male
Postoperative Complications
Reoperation
Retrospective Studies
Wisconsin