Pedaitics, University of Missouri-Kansas City, Kansas City, Missouri, USA.
Mathematics and Statistics, University of Missouri-Kansas City, Kansas City, Missouri, USA.
J Investig Med. 2020 Feb;68(2):413-418. doi: 10.1136/jim-2019-001028. Epub 2019 Sep 26.
Enteral access is one of the mainstays of nutritional support. Several different modalities for gastrostomy placement are established. In pediatrics, however, there is a limited evidence base supporting the choice of 1 modality over the others. We retrospectively compared elective percutaneous endoscopically placed gastrostomy (PEG) with surgical and interventional radiology-placed gastrostomy outcomes using the Pediatric Hospital Inpatient Sample multicenter administrative database (Pediatric Health Information System). Pediatric patients (<18 years) undergoing planned elective gastrostomy (2010-2015) were included. Coded gastrostomy procedure subtype, patient demographic characteristics, chronic comorbidities and subsequent related outcomes, mortality, readmission, length of stay and total cost of admission were analyzed. Univariate analysis differentiated among gastrostomy techniques. The effect of gastrostomy on mortality and 30-day readmission were determined using a forward, stepwise, binary logistic regression. Generalized linear models were used to estimate the effect of gastrostomy type on length of stay and total cost. During the study period, 11,712 children underwent gastrostomy, including PEG (27%). Patients with chronic comorbidities were more, or as likely to undergo non-PEG procedures. Postoperatively, PEG patients were less likely to require mechanical ventilation and total parenteral nutrition (TPN). Gastrostomy type was not predictive of mortality; predictors included non-White race and need for mechanically assisted ventilation. Readmission following gastrostomy was common (29.5%), and more likely in PEG patients (OR 1.31). Predictors of readmission included earlier TPN (OR 1.39), cardiovascular (OR 1.17) and oncology (OR 4.17) comorbidities. Our study suggests that PEG placement entails similar length of stay and cost as in non-PEG gastrostomy. Patients undergoing PEG were less likely to require mechanical ventilation and TPN postoperatively. Mortality is similar in both groups although more likely with specific comorbidities. Racial background appeared to be associated with choice of gastrostomy, length of stay and mortality.
肠内营养是营养支持的主要方法之一。已经确立了几种不同的胃造口术放置方式。然而，在儿科领域，支持选择 1 种方式而不是其他方式的证据有限。我们使用多中心行政数据库（儿科健康信息系统）回顾性比较了经皮内镜下放置胃造口术（PEG）与外科和介入放射学放置胃造口术的结果。纳入 2010 年至 2015 年期间计划行择期胃造口术的儿科患者（<18 岁）。分析了编码的胃造口术程序亚型、患者人口统计学特征、慢性合并症和随后的相关结局、死亡率、再入院、住院时间和住院总费用。单变量分析区分了胃造口术技术。使用正向、逐步、二元逻辑回归确定胃造口术对死亡率和 30 天再入院的影响。广义线性模型用于估计胃造口术类型对住院时间和总费用的影响。在研究期间，11712 名儿童接受了胃造口术，包括 PEG（27%）。患有慢性合并症的患者更有可能或更倾向于接受非 PEG 手术。术后，PEG 患者更不可能需要机械通气和全胃肠外营养（TPN）。胃造口术类型与死亡率无关；预测因素包括非白种人和需要机械辅助通气。胃造口术后再入院很常见（29.5%），PEG 患者更常见（OR 1.31）。再入院的预测因素包括早期 TPN（OR 1.39）、心血管（OR 1.17）和肿瘤（OR 4.17）合并症。我们的研究表明，PEG 放置与非 PEG 胃造口术的住院时间和费用相似。PEG 患者术后更不可能需要机械通气和 TPN。两组死亡率相似，但特定合并症的死亡率更高。种族背景似乎与胃造口术的选择、住院时间和死亡率有关。
