Estimating Adverse Events After Gastrostomy Tube Placement

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• 作者：Anne M. Stey ; MD ; MSc^a ; ^b ; ^{as013j@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Brian D. Kenney ; MD ; MPH^c ; Mark E. Cohen ; PhD^d ; R. Lawrence Moss ; MD^c ; Bruce L. Hall ; MD ; PhD ; MBA ; FACS^d ; ^e ; Loren Berman ; MD^f ; Kari Kraemer ; PhD^d ; Clifford Y. Ko ; MD ; MS ; MSHS ; FACS^b ; ^d ; Charles D. Vinocur ; MD^f
• 关键词：ACS-NSQIP-Pediatric ; children with special health care needs ; gastrostomy enteral access ; risk calculator
• 刊名：Academic Pediatrics
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：16
• 期：2
• 页码：129-135
• 全文大小：283 K

文摘

Gastrostomy feeding tube placement in children is associated with a high frequency of adverse events. This study sought to preoperatively estimate postoperative adverse events in children undergoing gastrostomy feeding tube placement.

Methods

This was an observational study of children who underwent gastrostomy with or without fundoplication at 1 of 50 participating hospitals, using 2011–2013 data from the American College of Surgeons' National Surgical Quality Improvement Program Pediatric. The outcome was the occurrence of any postoperative complications or mortality at 30 days after gastrostomy tube placement. The preoperative clinical characteristics significantly associated with occurrence of adverse events were included in a multivariate logistic model. The area under the receiver operating characteristic curve was computed to assess model performance and split-set validated.

Results

A total of 2817 children were identified as having undergone gastrostomy tube placement. The unadjusted rate of adverse events within 30 days after gastrostomy tube placement was 11%. Thirteen predictor variables were identified. Notable preoperative variables associated with a greater than 75% increase in adverse event rate were preoperative sepsis/septic shock (odds ratio [OR], 10.76, 95% confidence interval [CI], 3.84–30.17), central nervous system tumor (OR, 3.36; 95% CI, 1.42–7.95), the primary procedure as indicated by the current procedural terminology (CPT) linear risk variable (OR, 1.93; 95% CI, 1.50–2.49), severe cardiac risk factors (OR, 1.88; 95% CI, 1.17–3.03), and preoperative seizure history (OR, 1.90; 95% CI, 1.38–2.62). The area under the receiver operating characteristic curve was 0.71 with the derivation data set and 0.71 upon split-set validation.

Conclusions

Preoperatively estimating postoperative adverse events in children undergoing gastrostomy tube placement is feasible.