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Variability in the Method of Gastrostomy Placement in Children

Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI 53226, USA
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI 53226, USA
Author to whom correspondence should be addressed.
Received: 6 April 2020 / Revised: 17 April 2020 / Accepted: 28 May 2020 / Published: 1 June 2020
(This article belongs to the Section Pediatric Surgery)
Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients <18 years old undergoing percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) (including open or laparoscopic) from 1997 to 2012 were identified using the Kids’ Inpatient Database. Method of gastrostomy placement was evaluated using a multivariable mixed-effects logistic regression model with a random intercept term and a patient-age random-effect term. A total of 67,811 gastrostomy placements were performed during the study period. PEG was used in 36.6% of entries overall and was generally consistent over time. PEG placement was less commonly performed in infants (adjusted odds ratio [aOR] 0.30, 95%CI 0.26–0.33), children at urban hospitals (aOR: 0.38, 95%CI 0.18–0.82), and children cared for at children’s hospitals (aOR 0.57, 95%CI 0.48–0.69) and was more commonly performed in children with private insurance (aOR 1.17, 95%CI 1.09–1.25). Dramatic variability in PEG use was identified between centers, ranging from 0% to 100%. The random intercept and slope terms significantly improved the model, confirming significant center-level variability and increased variability among patients <1 year old. These findings emphasize the need to further evaluate the safest method of gastrostomy placement in children, in particular among the youngest patients in whom practice varies the most. View Full-Text
Keywords: gastrostomy; children; technique; variability gastrostomy; children; technique; variability
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MDPI and ACS Style

Salazar, J.H.; Spanbauer, C.; Sood, M.R.; Densmore, J.C.; Van Arendonk, K.J. Variability in the Method of Gastrostomy Placement in Children. Children 2020, 7, 53.

AMA Style

Salazar JH, Spanbauer C, Sood MR, Densmore JC, Van Arendonk KJ. Variability in the Method of Gastrostomy Placement in Children. Children. 2020; 7(6):53.

Chicago/Turabian Style

Salazar, Jose H., Charles Spanbauer, Manu R. Sood, John C. Densmore, and Kyle J. Van Arendonk 2020. "Variability in the Method of Gastrostomy Placement in Children" Children 7, no. 6: 53.

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