A. Ascencio2, S. Fingland1, J. Diaz-Miron1, J. Hills-Dunlap1, S. N. Acker1 1Children’s Hospital Colorado, Pediatric Surgery, Aurora, CO, USA 2University Of Colorado Denver, Surgery, Aurora, CO, USA
Introduction: Infants with congenital heart disease often undergo gastrostomy tube (GT) placement after initial cardiac repair for a variety of indications including inadequate caloric intake or aspiration related to transient injury to the recurrent laryngeal nerve during cardiac repair. Recent data suggest that many of these infants will quickly recover their ability to consume all calories orally once discharged home. We aimed to quantify gastrostomy related complications in this population in order to inform parental counseling discussions regarding the true risks and benefits of gastrostomy placement.
Methods: We performed a retrospective review of infants who underwent GT placement after an initial cardiac operation between 2018-2020 to ensure at least one year of follow up. Data were collected from the electronic medical record. Comparisons were made between infants who required GT for greater than one year and those who used it for less than one year.
Results: Sixty-seven infants underwent GT placement, 41 were male (61%). Indications for GT placement included aspiration (16, 24%), inadequate oral intake (44, 66%), as part of planned therapy for reflux (6, 9%), and after tracheostomy (1, 2%). Fifteen infants used the GT for feeds for one year or less (22%) including 7 infants (10%) who used the tube for three months or less. Twenty-four infants had their gastrostomy button removed during the follow up period (36%), 7 of whom required gastrocutaneous fistula (GCF) closure (30%). Complications occurred in 17 infants (25%) and included wound infection (1, 2%), granulation tissue within two weeks (1,2%), tube dislodgement (4, 6%), leakage from the tube (4, 6%), unplanned ED visit (8, 12%), unplanned readmission (1, 2%), other (3,4%). Children who kept their GT for more than one year were more likely to live in a rural location. Rates of staged operation (compared to initial definitive cardiac repair) were slightly higher among those who kept their g tube for >1 year (not statistically significant) (Table 1).
Conclusion: GT placement is associated with a complication about one fourth of the time and nearly as many infants use the tube for one year or less. Need for repeat operation to close the GCF occurs in about one third of children who have their tube removed. Infants who are likely to require a GT for longer periods of time are those who live in a rural area or whose initial operation was a staged procedure. Pediatric surgeons and cardiologists should consider the risks and benefits of GT placement as well as alternative means of supplemental feeding, including nasogastric feeding, when counseling families and making treatment recommendations.
