Correa Jesus A, Fallon Sara C, Murphy Kathleen M, Victorian Veronica A, Bisset George S, Vasudevan Sanjeev A, Lopez Monica E, Brandt Mary L, Cass Darrell L, Rodriguez J Ruben, Wesson David E, Lee Timothy C
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX.
J Pediatr Surg. 2014 Nov;49(11):1598-601. doi: 10.1016/j.jpedsurg.2014.06.015. Epub 2014 Aug 8.
Gastrostomy tube (GT) placement is a frequent procedure at a tertiary care children's hospital. Because of underlying patient illness and the nature of the device, patients often require multiple visits to the emergency room for GT-related concerns. We hypothesized that the majority of our patient visits to the ER related to gastrostomy tube concerns were not medically urgent. The purpose of this study was to characterize the incidence and indications for GT-related emergency room visits and readmission rates in order to develop family educational material that might allow for these nonurgent concerns to be addressed on an outpatient basis.
We reviewed the medical records of all patients with GT placement in the operating room from January 2011 to September 2012. We evaluated our primary outcome of ER visits at less than 30 days after discharge and 30-365 days after discharge. The purpose of the ER visit was categorized as either mechanical (dislodgement, leaking) or wound-related (infection, granulation tissue). Additional outcomes assessed included readmission rates, reoperation rates, and the use of gastrostomy contrast studies.
During the study period, 247 patients had gastrostomy tubes placed at our institution at a median age of 15.3 months (range 0.03 months-22 years). Of the total patient population, 219 were discharged less than 30 days after their operation (89%). Of these, 42 (20%) returned to the emergency room a total of 44 times within 30 days of discharge for concerns related to their GT. Avoidable visits related to leaking, mild clogs, and granulation tissue were seen in 17/44 (39%). An additional 40 patients among the entire cohort of 247 (16%) presented to the ER a total of 71 times 31-365 days post-discharge; 59 (83%) of these visits were potentially avoidable. The readmission rate related to the GT was low (4%).
Few studies have attempted to quantify the amount of postoperative resources utilized post-GT placement in children. Our findings indicated this is not an insignificant quantity. In response to these findings, we have developed a series of educational materials and identified a dedicated nurse to perform inpatient gastrostomy education to these patients prior to discharge.
胃造口管（GT）置入术是一家三级儿童专科医院的常见手术。由于患者的基础疾病以及该装置的特性，患者常常因与胃造口管相关的问题多次前往急诊室就诊。我们推测，大多数因胃造口管问题前来我院急诊室就诊的患者并非医学上急需处理。本研究的目的是描述与胃造口管相关的急诊室就诊的发生率和指征以及再入院率，以便编写可供患者家属阅读的教育资料，从而使这些非紧急问题能够在门诊得到解决。
我们回顾了2011年1月至2012年9月期间在手术室接受胃造口管置入术的所有患者的病历。我们评估了出院后不到30天以及出院后30 - 365天的急诊室就诊这一主要结局。急诊室就诊目的分为机械性（移位、渗漏）或与伤口相关（感染、肉芽组织）。评估的其他结局包括再入院率、再次手术率以及胃造口造影检查的使用情况。
在研究期间，我院共有247例患者接受了胃造口管置入术，中位年龄为15.3个月（范围0.03个月 - 22岁）。在全部患者中，219例（89%）在术后不到30天出院。其中，42例（20%）在出院后30天内因与胃造口管相关的问题共返回急诊室44次。17/44（39%）的就诊与渗漏、轻度堵塞和肉芽组织有关，这些情况是可以避免的。在247例患者这一整个队列中，另外40例（16%）在出院后31 - 365天共前往急诊室71次；其中59次（83%）就诊可能是可以避免的。与胃造口管相关的再入院率较低（4%）。
很少有研究试图量化儿童胃造口管置入术后所使用的术后资源量。我们的研究结果表明这一数量不容小觑。针对这些结果，我们编写了一系列教育资料，并指定了一名专门的护士在患者出院前对其进行住院胃造口术教育。
