Fox David, Campagna Elizabeth J, Friedlander Joel, Partrick David A, Rees Daniel I, Kempe Allison
*Department of Pediatrics, University of Colorado, Denver †Children's Outcomes Research Program, Children's Hospital Colorado, Aurora ‡Department of Economics §Department of Surgery, University of Colorado, Denver.
J Pediatr Gastroenterol Nutr. 2014 Nov;59(5):582-8. doi: 10.1097/MPG.0000000000000468.
National outcomes data regarding surgical gastrostomy tube (G-tube) and percutaneous endoscopic gastrostomy (PEG) tube procedures are lacking. Our objectives were to describe trends in G-tube and PEG procedures, examine regional variation, and compare outcomes.
This was a retrospective study using pediatric admissions during 1997, 2000, 2003, 2006, and 2009 from the Kids' Inpatient Database. Length of stay and cost were adjusted for demographics, complexity, setting, year, and infection or surgical complication.
G-tubes were placed during 64,412 admissions, increasing from 16.6 procedures/100,000 US children in 1997 to 18.5 in 2009. Surgical gastrostomy rates increased by 19% (0.17 procedures/100,000/year, P < 0.002) and, among children <1 year, they increased by 32% (2.56 procedures/100,000/year, P < 0.01). PEG rates did not increase (0.02 procedures/100,000/year, P = 0.47) in the study years. The West had an 18% higher rate than the national average for surgical G-tubes and a 10% higher rate for PEGs. When the sole procedure during the admission was gastrostomy, the G-tube was associated with a 19% (confidence interval 9.7-57.5) longer length of stay, and a 25% higher cost (confidence interval 16.4-34.5) compared with PEG.
Surgical gastrostomy insertion rates have increased whereas PEG rates have not, despite evidence of better severity-adjusted outcome measures for PEG tubes. Surgical gastrostomy insertion in children <1 year of age yielded the greatest increase, which may relate to a changing patient population; however, regional variation suggests that provider preference also plays a role. Our data underline the need for more robust collection and analysis of surgical outcomes to guide decision making.
目前缺乏关于外科胃造口管（G管）和经皮内镜下胃造口术（PEG）操作的全国性结局数据。我们的目的是描述G管和PEG操作的趋势，研究地区差异，并比较结局。
这是一项回顾性研究，使用了儿童住院数据库中1997年、2000年、2003年、2006年和2009年的儿科住院病例。住院时间和费用根据人口统计学、复杂性、治疗环境、年份以及感染或手术并发症进行了调整。
在64412例住院病例中放置了G管，从1997年每10万名美国儿童中有16.6例操作增加到2009年的18.5例。外科胃造口术的发生率增加了19%（每年0.17例/10万，P<0.002），在1岁以下儿童中，发生率增加了32%（每年2.56例/10万，P<0.01）。在研究年份中，PEG发生率没有增加（每年0.02例/10万，P=0.47）。西部外科G管的发生率比全国平均水平高18%，PEG的发生率高10%。当住院期间唯一的操作是胃造口术时，与PEG相比，G管与住院时间延长19%（置信区间9.7-57.5）和费用高25%（置信区间16.4-34.5）相关。
尽管有证据表明PEG管在调整严重程度后的结局指标更好，但外科胃造口术的插入率增加了，而PEG率没有增加。1岁以下儿童的外科胃造口术插入率增加最多，这可能与患者群体的变化有关；然而，地区差异表明医疗服务提供者的偏好也起了作用。我们的数据强调需要更有力地收集和分析手术结局以指导决策。
