H. Osei1,2, A. S. Abraham1,2, S. Kazmi2, A. Martino2, K. Bates2, J. S. Kim2, J. Myint2, K. Chatoorgoon1,2, J. Greenspon1,2, F. Colleen1,2, G. A. Villalona1,2 1Cardinal Glennon Children’s Hospital,Pediatric Surgery,St. Louis, MO, USA 2St. Louis University,School Of Medicine,St. Louis, MO, USA
Introduction:
Outcomes between primary gastrostomy tubes and buttons have not been established in pediatric patients. We hypothesized that primary gastrostomy tubes have decreased complications when compared to buttons.
Methods:
A retrospective review of all surgeon-placed gastrostomy devices from 2010 to 2017 was performed. Data collected included demographics, outcomes and 90 day complications. We divided the patients into primary gastrostomy tubes (Group A) and primary gastrostomy buttons (Group B). We excluded patients who underwent standard open Stamm and PEG procedures. Primary outcome was postoperative major complication defined as need for NPO/TPN or surgery due to external leaks, and need for surgery due to granulation tissue or dislodgement. Groups were compared using chi-square test for categorical data and independent t-test for continuous data. Multivariable analysis using binary logistic regression was performed for simultaneous assessment of predictive factors for major complication. All data evaluation were performed using SPSS Version 24 (Armonk, NY: IBM Corp). Outcomes with p ≤ 0.05 (two-sided) were considered significant.
Results:
Of the 265 patients, 142 (53.6%) were male. Median age and weight at the time of surgery were 7 months (IQR, 2 – 44 months) and 6.70 kg (IQR, 3.98 – 14.15 kg) respectively. Group A (G-tube) had 80 patients (30.2%), whiles Group B (G-button) had 185 patients (69.8%). There were 153 complications within 90 days. These were categorized into minor (n= 142 {92.8%}) and major (n= 11{7.2%}) complications. There was no significant difference in overall complications between groups (Group A, 63.8% vs Group B, 55.7%, p= 0.192). More importantly, there were no significant difference in major complications among the two groups (Group A, 5% vs Group B, 3.8%, p= 0.455). However, when adjusted for type of gastrostomy device placed, the independent predictive factors for major complication were preoperative antibiotics (adjusted odds ratio [aOR], 14.82 {CI: 2.60 – 84.34}, p= 0.002) and open procedure (aOR, 6.14 {1.01 – 37.24}, p= 0.049).
Conclusion:
Primary gastrostomy tubes have no significant difference in overall or major complications, when compared to primary buttons. However, preoperative antibiotics and open procedures may be independent predictive factors for major complication when adjusted for type of device placed.
