Delayed Gastrostomy Tube Placement in Down Syndrome Patients with Duodenal Atresia Significantly Increases Length of Stay
*Nathan L Maassel, Daniel G Solomon, David Stitelman
Yale, New Haven, CT
Objective: Approximately one third of infants with duodenal atresia (DA) have concomitant Down syndrome (DS). DS patients have known feeding difficulties, and in addition to surgical repair of DA, occasionally need gastrostomy tube placement. We sought to define predictors of tube placement in DA patients with DS.
Design: Retrospective review
Setting: Children’s Hospital Association Hospitals within the Pediatric Health Information System (PHIS)
Patients: Infants <10 days old, admitted 2015-2018, ICD-10 codes for DA and DS in addition to procedure codes for intestinal bypass or duodenoduodenostomy. The cohort was additionally queried gastrostomy tube procedure codes during the same admission.
Interventions: None
Main Outcome Measures: demographics/comorbidities predictive of tube placement (primary), length of stay (secondary)
Results: 209 infants were identified with DA and DS in addition to an intestinal bypass procedure. Of those, 57 (27%) had tubes placed. On univariate analysis comparing patients with and without gastrostomy tubes, only tracheoesophageal fistula (3 with gastrostomy, 0 without, p=0.02) and length of stay (59.40 ± 47.34 days with gastrostomy vs 45.35 ± 40.36 days without) were statistically significant. When stratifying patients by timing of tube placement (during bypass N=27 vs delayed N=30) length of stay remained as the only significant difference between the two groups (44.70 ±36.72 days - tube during bypass vs 72.6 ±52.34 days - delayed tube, p=0.0032) with no significant difference in complications. Conclusions: Delayed gastrostomy tube placement in DS patients with significantly increases length of stay compared to those placed at the time of their initial operation.
| Timing of Gastrostomy Tube | |||
| after(N=30) | during(N=27) | p-value | |
| Birthweight (Grams) | 2599.08±738.28 | 2490.54 ± 709.13 | 0.480 |
| Gestational Age in (Weeks) | 36.00 ± 2.98 | 35.75 ± 3.35 | 0.947 |
| Apgar 1 Minute Score | 6.00 ± 2.85 | 6.44 ± 2.66 | 0.574 |
| Apgar 5 Minute Score | 7.20 ± 3.05 | 7.69 ± 2.33 | 0.816 |
| Median Household Income (dollars) | 44825.67 ± 161780.40 | 44966.30 ± 14706.00 | 0.842 |
| Length of Stay (days) | 72.63 ± 52.34 | 44.70 ± 36.72 | 0.003 |
| Gender (Male) | 16(53%) | 11(41%) | 0.429 |
| Race (Non-white) | 10(33%) | 9(33%) | 1 |
| Payor (Government) | 19(63%) | 16(59%) | 0.752 |
| Gastrostomy Complication | 5(17%) | 5(19%) | 0.722 |
| Comorbidities | |||
| Atrial Septal Defect | 24(80%) | 16(59%) | 0.146 |
| Ventricular Septal Defect | 14(47%) | 12(44%) | 1 |
| Atrioventricular Septal Defect | 7(23%) | 8(29%) | 0.590 |
| Tetralogy of Fallot | 1(3%) | 3(11%) | 0.336 |
| Tracheoesophageal Fistula | 1(3%) | 2(7%) | 0.599 |
| Anorectal Malformation | 1(3%) | 0 | 1 |
| Annular pancreas | 5(17%) | 4(15%) | 1 |
| Hirschsprung''s disease | 1(3%) | 1(4%) | 1 |
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