Jensen Amanda R, Renaud Elizabeth, Drucker Natalie A, Staszak Jessica, Senay Ayla, Umesh Vaibhavi, Williams Regan F, Markel Troy A
Department of Surgery, Division of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
Department of Surgery, Division of Pediatric Surgery, Albany Medical Center, Albany, NY.
J Pediatr Surg. 2018 Apr;53(4):656-660. doi: 10.1016/j.jpedsurg.2017.06.015. Epub 2017 Jun 27.
Early initiation of feedings after gastrostomy tube (GT) placement may reduce associated hospital costs, but many surgeons fear complications could result from earlier feeds. We hypothesized that, irrespective of placement method, starting feedings within the first 6h following GT placement would not result in a greater number of post-operative complications.
An IRB-approved retrospective review of all GTs placed between January 2012 and December 2014 at three academic institutions was undertaken. Data was stratified by placement method and whether the patient was initiated on feeds at less than 6h or after. Baseline demographics, operative variables, post-operative management and complications were analyzed. Descriptive statistics were used and P-values <0.05 were considered significant.
One thousand and forty-eight patients met inclusion criteria. GTs were inserted endoscopically (48.9%), laparoscopically (44.9%), or via an open approach (6.2%). Demographics were similar in early and late fed groups. When controlling for method of placement, those patients who were fed within the first 6h after gastrostomy placement had shorter lengths of stay compared to those fed greater than 6h after placement (P<0.05). Total post-operative outcomes were equivalent between feeding groups for all methods of placement (laparoscopic (P=0.87), PEG (P=0.94), open (P=0.81)).
Early initiation of feedings following GT placement was not associated with an increase in complications. Feeds initiated earlier may shorten hospital stays and decrease overall hospital costs.
Multi-institutional retrospective.
III.
胃造口管（GT）置入术后早期开始喂养可能会降低相关的住院费用，但许多外科医生担心早期喂养可能会导致并发症。我们假设，无论置入方法如何，在GT置入后的前6小时内开始喂养不会导致更多的术后并发症。
对2012年1月至2014年12月期间在三家学术机构置入的所有GT进行了一项经机构审查委员会批准的回顾性研究。数据按置入方法以及患者是否在6小时内或之后开始喂养进行分层。分析了基线人口统计学、手术变量、术后管理和并发症。采用描述性统计，P值<0.05被认为具有统计学意义。
1048例患者符合纳入标准。GT通过内镜置入（48.9%）、腹腔镜置入（44.9%）或开放手术置入（6.2%）。早期和晚期喂养组的人口统计学特征相似。在控制置入方法后，与胃造口术后6小时后开始喂养的患者相比，在胃造口术后6小时内开始喂养的患者住院时间更短（P<0.05）。对于所有置入方法，各喂养组的术后总结果相当（腹腔镜置入（P=0.87）、经皮内镜下胃造口术（PEG）（P=0.94）、开放手术（P=0.81））。
GT置入术后早期开始喂养与并发症增加无关。早期开始喂养可能会缩短住院时间并降低总体住院费用。
多机构回顾性研究。
III级。
