Salazar Jose H, Spanbauer Charles, Sood Manu R, Densmore John C, Van Arendonk Kyle J
Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI 53226, USA.
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Children (Basel). 2020 Jun 1;7(6):53. doi: 10.3390/children7060053.
Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients <18 years old undergoing percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) (including open or laparoscopic) from 1997 to 2012 were identified using the Kids' Inpatient Database. Method of gastrostomy placement was evaluated using a multivariable mixed-effects logistic regression model with a random intercept term and a patient-age random-effect term. A total of 67,811 gastrostomy placements were performed during the study period. PEG was used in 36.6% of entries overall and was generally consistent over time. PEG placement was less commonly performed in infants (adjusted odds ratio [aOR] 0.30, 95%CI 0.26-0.33), children at urban hospitals (aOR: 0.38, 95%CI 0.18-0.82), and children cared for at children's hospitals (aOR 0.57, 95%CI 0.48-0.69) and was more commonly performed in children with private insurance (aOR 1.17, 95%CI 1.09-1.25). Dramatic variability in PEG use was identified between centers, ranging from 0% to 100%. The random intercept and slope terms significantly improved the model, confirming significant center-level variability and increased variability among patients <1 year old. These findings emphasize the need to further evaluate the safest method of gastrostomy placement in children, in particular among the youngest patients in whom practice varies the most.
尽管胃造口术置管是儿童中最常见的手术之一，但最佳技术仍不明确。本研究的目的是评估美国儿童胃造口术置管方法的变异性。使用儿童住院数据库识别1997年至2012年期间接受经皮内镜下胃造口术（PEG）或手术胃造口术（SG，包括开放或腹腔镜手术）的18岁以下患者。使用具有随机截距项和患者年龄随机效应项的多变量混合效应逻辑回归模型评估胃造口术置管方法。在研究期间共进行了67,811例胃造口术置管。总体而言，36.6%的病例使用了PEG，且随时间基本保持一致。PEG置管在婴儿中较少进行（调整优势比[aOR]为0.30，95%置信区间[CI]为0.26 - 0.33），在城市医院的儿童中较少进行（aOR：0.38，95%CI为0.18 - 0.82），在儿童医院接受治疗的儿童中较少进行（aOR为0.57，95%CI为0.48 - 0.69），而在有私人保险的儿童中更常进行（aOR为1.17，95%CI为1.09 - 1.25）。各中心之间PEG使用情况存在显著差异，范围从0%到100%。随机截距和斜率项显著改善了模型，证实了显著的中心水平变异性以及1岁以下患者之间变异性增加。这些发现强调需要进一步评估儿童胃造口术置管的最安全方法，特别是在实践差异最大的最年幼患者中。
