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Institutional Variation in Gastrostomy Tube Placement after Duodenal Atresia Repair in Children with Trisomy 21
Nathan L. Maassel1, Mary Elizabeth Guerra1, Daniel Solomon2, David Stitelman2
1Surgery, Yale School of Medicine, New Haven, Connecticut, United States, 2Department of Surgery, Division of Pediatric Surgery, Yale School of Medicine, New Haven, Connecticut, United States

1. Objective. To compare institutional practice patterns for gastrostomy tube placement in neonates with duodenal atresia (DA) and trisomy 21.
2. Design. Retrospective, cross-sectional review
3. Setting. Pediatric Health Information System (PHIS) from 2015-2018.
4. Patients (or Other Participants). Infants admitted at < 10 days. Inclusion required ICD-10 diagnostic codes for both DA and trisomy 21, in addition to a procedure code for either intestinal bypass or duodenoduodenostomy. This cohort was then queried for gastrostomy tube procedure codes and diagnostic codes for associated co-morbidities.
5. Interventions (if any). n/a
6. Main Outcome Measure (s). Institutional rate of gastrostomy tube placement in infants with DA and trisomy 21. Determining influence of patient or institutional characteristics on institutional gastrostomy tube placement.
7. Results. In total, 209 infants were identified with DA and trisomy 21 in addition to an intestinal bypass. Of those, 57 (27%) had gastrostomy tubes placed. Of the 46 hospitals, 16 (35%) placed no gastrostomy tubes during a child"s index admission. Hospitals that never placed gastrostomy tubes during a child"s index admission ("No G-tube hospitals") more frequently performed laparoscopic DA repairs (35% of children from No G-tube hospitals vs 11% from G-tube hospitals, p<0.0001) but were otherwise similar regarding patient and institutional characteristics compared to institutions that placed at least one gastrostomy tube ("G-tube hospitals") (Table).
8. Conclusions. A large proportion of institutions within the PHIS do not place gastrostomy tubes during the index admission for neonates with trisomy 21 and DA yet have similar patient and institutional characteristics overall. Gastrostomy tube placement may be unnecessary in a larger proportion of this specific patient population.

Comparison of Institutions That Do and Do Not Place Gastrostomy Tubes in Patients with Duodenal Atresia and Trisomy 21
Patient Characteristics No G-tube Hospital
Patients
(N=57)
G-tube Hospital Patients
(N=152)
p-value
Birthweight, mean, grams 2692.4 745.52638.2 617.20.33
Length of stay, mean, days 36.3 2.648 43.40.07
Payor (private) 38.2 30.173 (48%)0.03
Race (non-white) 37 (65%)48 (32%)0.32
Gender (female) 14 (25%)74 (49%)0.87
Procedure type (open) 20 (35%)16 (11%)<0.0001
Cardiac anomaly 27 (47%)83 (55%)0.35
Tracheoesophageal Fistula 03 (2%)0.17
Anorectal Malformation 1 (2%)3 (2%)0.92
Hirschsprung Disease 1 (2%)5 (3%)0.53
Gestational age, mean, weeks 36.3 2.636.2 2.60.92
__________________________________________________________________________________________________________________________________
Hospital Characteristics No G-tube Hospitals
(N= 16)
G-tube Hospitals
(N = 30)
p-value
Hospital Size, mean bed number 386.9 193.6341.4 118.30.70
Hospital RegionMidwest4 (25%)9 (30%)0.81
 Northeast1 (6%)4 (13%) 
 South7 (44%)10 (33%) 
 West4 (25%)7 (23%) 


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